Asperger’s and Autism

Hans Asperger

It should go without saying that making an accurate and specific diagnosis is key to helping each patient, even if there is no current successful therapy. That is because, as medicine describes other patients with a similar set of signs and symptoms, there will be word of treatments and other important and pertinent research.

This could lead to improvement, cure or prevention, maybe not in a particular patient at this time, but perhaps in a few years or for the next generation. This is what I often say to parents who exclaim, “I don’t care what the diagnosis is, just help my child!”

One of the most enigmatic conditions that I treat is Asperger’s Syndrome. Wikipedia gives an thorough summary of the condition. This blog will cover my experience with the disorder. First, I object to the term as being equal to “high-functioning autism.” Not only do I believe that Temple Grandin is a ‘high functioning autistic’, she’s a higher functioning person than I am! I never wrote a book, or designed a cattle ranch, and no movie has been made about me… you get the point.

If ‘high-functioning autism’ is a term that parents and patients want to agree upon, so be it. Many such individuals do not wish to even seek medical intervention, anyway. Secondly, in a similar manner, I object to the morphing of a diagnosis into Asperger’s. That is, if you are a ‘high functioning’ autistic person with difficulties in a social atmosphere and odd behaviors, then you must have outgrown your previous diagnosis of autism and magically became an ‘aspie’.

Finally, I object to the adjective because I have treated patients with Asperger’s diagnosis who weren’t so ‘high functioning’. I believe that this point of view is important because it involves making the correct diagnosis.

Simply because some medical condition appears to look like another medical entity does not mean that the conditions are alike. Coughing blood and weight loss can be from an infection, toxins, or cancer, among other diseases. The cause is all important when you have an infection; that is, which organism you are treating will determine which antibiotic you choose.

The assumption that Asperger’s Syndrome is a form of autism, differing only in degree or severity, may not be correct. We don’t even know what autism is, or what causes it, or how to prevent it, or whether the regressive is the same disorder as the congenital form, so why should we assume that Asperger’s is just a form of it? These assumptions may actually further our ignorance by impeding the search for more specific knowledge.

And, I don’t have a problem with the proposed DSM V inclusion under the ‘Spectrum’ umbrella. Heck, utilizing psychiatric diagnostic criteria for autism is wrong in the first place. Also, if it gets services for affected individuals, that is ultimately the goal anyway. That is what Dr. Lars Perner (an ‘aspie’) said at a recent meeting regarding the diagnostic changes. Dr. Nestor Lopez-Duran provides a thorough treatment of this topic in his child psychiatry blog.

This brings me to the present lack of state-of-the-art regarding treatments for Asperger’s Syndrome. To the extent that ‘stims’, perseveration or repetitive movements relate to gut disorder, biomedical treatments can be effective for selected individuals. When food allergies or sleep disturbances are treated safely and effectively, such interventions assist with better focus and concentration. If symptoms relate to metabolic slowdown that improves with increased energy by way of nutritional supplements, biomedical initiatives appear to improve a particular Asperger’s patient’s symptoms. Calming agents such as pycnogenol or magnesium could have some effects that improve anxiety in social situations, for example.

The ADHD symptoms that often accompany this developmental disorder can improve with stimulant medications. However, getting on that pharmaceutical merry-go-round is no picnic and requires close observation and frequent changes. OCDs tend to be treated with same tonics that were invented for much older patients with psychiatric disturbances and have limited success. Oppositional behaviors are sometimes amenable to low dose naltrexone therapy.

But the overall improvement that a patient would seek – in both social and communication domains – requires a great deal of thought and planning to treat successfully. Sensory problems have a myriad of therapies (e.g. neurofeedback, Tomatis, Relationship Development Intervention), with varying degrees of improvement. Eye contact and conversational norms do not lend themselves to medical intervention and are fairly resistant to psychological counseling.  This is when social situations, from the Scouts, to horse therapy, to martial arts, to appropriate sports activities (swimming or track rather than cooperative team sports) can make a great deal of difference in the patient’s life. For certain teens, learning magic, for example, is a great way to gain social acceptance. ABA – behavioral intervention can be a powerful tool.

Doctors need to keep an open mind since recognition of this diagnosis is often elusive. The New York Times has been publishing a wonderful series of articles about the autism disorders, and there were recent posts about Asperger’s Syndrome in particular.

The more awareness that this disorder gets, the more likely that there will be research into etiology, diagnosis, and effective treatments. There are many ‘aspies’ out in the world living productive lives, we just need to get each child on the correct path.

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Brian D. Udell MD
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