Asperger syndrome is part of the autism spectrum disorder (ASD), a group of disorders that affects the development of social and communication skills. Unlike many children with ASD, children with Asperger syndrome do not have early language delays, and often have well developed language skills and normal to above average intelligence. However, they may use unusual speech patterns and have a hard time understanding irony, humor, and sarcasm or gestures and social cues important to normal conversation. Many children with Asperger syndrome develop an obsessive interest in one topic or object. They may use high-level vocabulary or complex statistics in conversation. Children with Asperger syndrome may have delayed motor skills and thus can appear uncoordinated and clumsy compared to their peers. Other features of Asperger syndrome include difficulty interacting with peers, inappropriate social or emotional behavior, and engaging in repetitive routines. Both children and adults with Asperger syndrome are at an increased risk for depression, attention deficit hyperactivity disorder (ADHD), mood and anxiety disorders, and other mental health disorders.

The cause of Asperger syndrome, like most ASDs, is not fully understood, but there is a strong genetic basis, which means it does tend to run in families. Multiple environmental factors are also thought to play an important role in the development of all ASDs.

Treatment for Asperger syndrome depends on each person's age and needs, and the recommendation is for treatment to begin as early as possible. Many people with Asperger syndrome can learn strategies to manage their symptoms. Treatment may include behavioral therapy, speech and language therapy, support in school, and mental health counseling. Medications may sometimes be used for behavioral or mood disorders.

Of note: the newest edition, updated in 2013, of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is used predominantly in the United States (US), replaced the terms Asperger syndrome and other pervasive developmental disorders with the umbrella diagnosis of autism spectrum disorder. This means that currently, Asperger syndrome is not officially considered a separate disorder in US, but instead it is now part of the autism spectrum disorder (ASD). However, many doctors still use this term. The World Health Organization International Classification of Diseases, (ICD-11) which is used in other countries throughout the world still uses Asperger syndrome as a subtype of ASD.

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Some people with ASD have a known difference, such as a genetic condition. Other causes are not yet known. Scientists believe there are multiple causes of ASD that act together to change the most common ways people develop. We still have much to learn about these causes and how they impact people with ASD.

People with ASD may behave, communicate, interact, and learn in ways that are different from most other people. There is often nothing about how they look that sets them apart from other people. The abilities of people with ASD can vary significantly. For example, some people with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives; others can work and live with little to no support.

ASD begins before the age of 3 years and can last throughout a person’s life, although symptoms may improve over time. Some children show ASD symptoms within the first 12 months of life. In others, symptoms may not show up until 24 months of age or later. Some children with ASD gain new skills and meet developmental milestones until around 18 to 24 months of age, and then they stop gaining new skills or lose the skills they once had.

As children with ASD become adolescents and young adults, they may have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may come to the attention of healthcare providers because they also have conditions such as anxiety, depression, or attention-deficit/hyperactivity disorder, which occur more often in people with ASD than in people without ASD.

Signs and Symptoms

People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. It is important to note that some people without ASD might also have some of these symptoms. For people with ASD, these characteristics can make life very challenging.

Diagnosis

Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s behavior and development to make a diagnosis. ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered reliable.¹ However, many children do not receive a final diagnosis until they are much older. Some people are not diagnosed until they are adolescents or adults. This delay means that people with ASD might not get the early help they need.

Treatment

Current treatments for ASD seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs.Treatment plans usually involve multiple professionals and are catered to the individual.

Risk Factors

There is not just one cause of ASD. There are many different factors that have been identified that may make a child more likely to have ASD, including environmental, biologic, and genetic factors.

Although we know little about specific causes, the available evidence suggests that the following may put children at greater risk for developing ASD:

• Having a sibling with ASD
• Having certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis
• Experiencing complications at birth
• Being born to older parents

CDC is currently working on one of the largest U.S. studies to date on ASD. This study called the Study to Explore Early Development (SEED), was designed to look at the risk factors and behaviors related with ASD. CDC is now conducting a follow-up study of older children who were enrolled in SEED to determine the health, functioning, and needs of people with ASD and other developmental disabilities as they mature.

How Often ASD Occurs

CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network has been estimating the number of 8-year-old children with ASD in the United States since 2000.

ASD occurs in all racial, ethnic, and socioeconomic groups. It is more than 4 times more common among boys than among girls.

If You’re Concerned

As a parent, you already have what it takes to help your young child learn and grow. CDC has developed materials to help you track your child’s developmental milestones and share that progress, or any concerns, with your child’s doctor at every check-up.

Contact your child’s doctor if you think your child might have ASD or if you have any other concerns about the way your child plays, learns, speaks, or acts.

If you are still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. Specialists who can do a more in-depth evaluation and make a diagnosis include

• Developmental pediatricians (doctors who have special training in child development and children with special needs)
• Child neurologists (doctors who work on the brain, spine, and nerves)
• Child psychologists or psychiatrists (doctors who know about the human mind)

At the same time, call your state’s public early childhood system to request a free evaluation, sometimes called a Child Find evaluation, to find out if your child qualifies for intervention services. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

• If your child is not yet 3 years old, contact your local early intervention system.
  • You can find the right contact information for your state by calling the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001.
• If your child is 3 years old or older, contact your local public school system.
  • Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
  • If you’re not sure who to contact, call the ECTA at 919-962-2001.

Research shows that early intervention services can greatly improve a child’s development. In order to make sure your child reaches their full potential, it is very important to receive services as soon as possible.

Asperger syndrome (AS) is a developmental disorder that is characterized by:

• Limited interests or an unusual preoccupation with a particular subject to the exclusion of other activities
• Repetitive routines or rituals
• Peculiarities in speech and language, such as speaking in an overly formal manner or in a monotone, or taking figures of speech literally
• Socially and emotionally inappropriate behavior and the inability to interact successfully with peers
• Problems with non-verbal communication, including the restricted use of gestures, limited or inappropriate facial expressions, or a peculiar, stiff gaze
• Clumsy and uncoordinated motor movements

AS is an autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. Other ASDs include: classic autism, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS).

Parents usually sense there is something unusual about a child with AS by the time of his or her third birthday, and some children may exhibit symptoms as early as infancy. Unlike children with autism, children with AS retain their early language skills. Motor development delays--crawling or walking late, clumsiness--are sometimes the first indicator of the disorder.

The incidence of AS is not well established, but experts in population studies conservatively estimate that two out of every 10,000 children have the disorder. Boys are three to four times more likely than girls to have AS.

Studies of children with AS suggest that their problems with socialization and communication continue into adulthood. Some of these children develop additional psychiatric symptoms and disorders in adolescence and adulthood.

Although diagnosed mainly in children, AS is being increasingly diagnosed in adults who seek medical help for mental health conditions such as depression, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD). No studies have yet been conducted to determine the incidence of AS in adult populations.

In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition "autistic psychopathy" and described it as a personality disorder primarily marked by social isolation.

Asperger's observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called "Asperger's" syndrome. Wing's writings were widely published and popularized. AS became a distinct disease and diagnosis in 1992, when it was included in the tenth published edition of the World Health Organization's diagnostic manual, International Classification of Diseases (ICD-10), and in 1995, when it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association's diagnostic reference book.

What is Asperger syndrome?

Asperger syndrome (AS) is a developmental disorder. It is an autism spectrum disorder (ASD), one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. Other ASDs include: classic autism, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Unlike children with autism, children with AS retain their early language skills.

The most distinguishing symptom of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other. Children with AS want to know everything about their topic of interest and their conversations with others will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors. Other characteristics of AS include repetitive routines or rituals; peculiarities in speech and language; socially and emotionally inappropriate behavior and the inability to interact successfully with peers; problems with non-verbal communication; and clumsy and uncoordinated motor movements.

Children with AS are isolated because of their poor social skills and narrow interests. They may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular interest. Children with AS usually have a history of developmental delays in motor skills such as pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.

Is there any treatment?

The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.

An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior. It may include social skills training, cognitive behavioral therapy, medication for co-existing conditions, and other measures.

What is the prognosis?

With effective treatment, children with AS can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

Twin and family studies suggest there is a genetic vulnerability to AS and the other ASDs, but a specific gene for AS hasn't been identified. It is likely that multiple genes cause AS, since the symptoms and the severity of symptoms vary so widely among individuals.

Researchers recently identified an association between certain behavioral traits (the insistence on strict routines and repetitive behavior) in a group of children with autism and a specific gene--GABRB3. Another study discovered a strong association between autism and the mutation of a gene the researchers call ENGRAILED 2. Additional evidence for the link between inheritable genetic mutations and AS is seen in the higher incidence of family members of children with an ASD who have similar behavioral symptoms, but in a more limited form. For example they may have mild social, language, or reading problems.

Current research points to structural abnormalities in the brain as a cause of AS. These abnormalities impact neural circuits that control thought and behavior. Researchers think that gene/environment interactions cause some genes to turn on or turn off, or turn on too much or too little in the wrong places, and this interferes with the normal migration and wiring of embryonic brain cells during early development.

Researchers at the University of California, supported in part by the National Institutes of Health, have proposed the disorder stems from abnormal changes that happen during critical stages of fetal development. Defects in the genes that control and regulate normal brain growth create abnormal growth patterns, which cause overgrowth in some brain structures and reduced growth, or excessive cell loss, in others.

Using advanced brain imaging techniques, scientists have revealed structural and functional differences in specific brain regions between the brains of normal versus AS children. One study found a lack of activity in the frontal lobe of AS children when asked to respond to tasks that required them to use their judgment. Another found differences in brain activity when children were asked to respond to facial expressions. Other methods of investigating brain function have revealed abnormal levels of particular proteins in the brains of adults with AS, which correlate with obsessive and repetitive behaviors.

The most distinguishing symptom of AS is a child's obsessive interest in a single object or topic to the exclusion of any other. Some children with AS have become experts on vacuum cleaners, makes and models of cars, even objects as odd as deep fat fryers. Children with AS want to know everything about their topic of interest and their conversations with others will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors.

Children with AS will gather enormous amounts of factual information about their favorite subject and will talk incessantly about it, but the conversation may seem like a random collection of facts or statistics, with no point or conclusion.

Their speech may be marked by a lack of rhythm, an odd inflection, or a monotone pitch. Children with AS often lack the ability to modulate the volume of their voice to match their surroundings. For example, they will have to be reminded to talk softly every time they enter a library or a movie theatre.

Unlike the severe withdrawal from the rest of the world that is characteristic of autism, children with AS are isolated because of their poor social skills and narrow interests. In fact, they may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular interest.

Children with AS usually have a history of developmental delays in motor skills such as pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.

Many children with AS are highly active in early childhood, and then develop anxiety or depression in young adulthood. Other conditions that often co-exist with AS are ADHD, tic disorders (such as Tourette's syndrome), depression, anxiety disorders, and OCD.

The diagnosis of AS is complicated by the lack of a standardized diagnostic screen or schedule. In fact, because there are several screening instruments in current use, each with different criteria, the same child could receive different diagnoses, depending on the screening tool the doctor uses.

To further complicate the issue, some doctors believe that AS is not a separate and distinct disorder. Instead, they call it high-functioning autism (HFA), and view it as being on the mild end of the ASD spectrum with symptoms that differ--only in degree--from classic autism. Some clinicians use the two diagnoses, AS or HFA, interchangeably. This makes gathering data about the incidence of AS difficult, since some children will be diagnosed with HFA instead of AS, and vice versa.

Most doctors rely on the presence of a core group of behaviors to alert them to the possibility of a diagnosis of AS. These are:

• Abnormal eye contact
• Aloofness
• The failure to turn when called by name
• The failure to use gestures to point or show
• A lack of interactive play
• A lack of interest in peers

Some of these behaviors may be apparent in the first few months of a child's life, or they may appear later. Problems in at least one of the areas of communication and socialization or repetitive, restricted behavior must be present before the age of three.

The diagnosis of AS is a two-stage process. The first stage begins with developmental screening during a "well-child" check-up with a family doctor or pediatrician. The second stage is a comprehensive team evaluation to either rule in or rule out AS. This team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS.

The comprehensive evaluation includes neurologic and genetic assessment, with in-depth cognitive and language testing to establish intelligence quotient (IQ) and evaluate psychomotor function, verbal and non-verbal strengths and weaknesses, style of learning, and independent living skills. An assessment of communication strengths and weaknesses includes evaluating non-verbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities, and humor); patterns of inflection, stress and volume modulation; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity, and coherence of conversation. The physician will look at the testing results and combine them with the child's developmental history and current symptoms to make a diagnosis.

Health care providers no longer consider Asperger syndrome to be a valid diagnosis for milder symptoms of autism. Under the American Psychiatric Association's new diagnostic criteria for mental disorders, or the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5), people with very severe symptoms of autism and people with milder symptoms who were previously diagnosed with Asperger syndrome now are considered to have the same diagnosis of ASD.

However, if your child has already been diagnosed with Asperger syndrome, he or she should not have to be re-evaluated by a health care provider to receive a diagnosis of ASD.

Some people with the milder form of autism once known as Asperger syndrome consider the diagnostic label to be a part of their identity. There is nothing wrong with continuing to use this term to describe oneself or to identify with a peer group, even though the official diagnostic term has changed.

The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.

An effective treatment program builds on the child's interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child's attention in highly structured activities, and provides regular reinforcement of behavior. This kind of program generally includes:

• Social skills training, a form of group therapy that teaches children with AS the skills they need to interact more successfully with other children
• Cognitive behavioral therapy, a type of "talk" therapy that can help the more explosive or anxious children to manage their emotions better and cut back on obsessive interests and repetitive routines
• Medication, for co-existing conditions such as depression and anxiety
• Occupational or physical therapy, for children with sensory integration problems or poor motor coordination
• Specialized speech/language therapy, to help children who have trouble with the pragmatics of speech--the give and take of normal conversation
• Parent training and support, to teach parents behavioral techniques to use at home

With effective treatment, children with AS can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.