Asperger syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Autism Spectrum Disorder (ASD) is a category of neurodevelopmental disorders with problems in social communication/interaction and restricted and repetitive behaviors/interests. According to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5) released by the American Psychiatric Association (APA) in 2013, Asperger Syndrome (AS) goes under a spectrum of disorders called ‘Autism Spectrum Disorder (ASD)’.^[1] Asperger Syndrome is named after Hans Asperger, an Austrian physician. He was the first to describe and separate Asperger Syndrome from autism and called it ‘autistic psychopathy’ which later became known as Asperger Syndrome.

Asperger Syndrome (AS) is believed to be first described as ‘autistic psychopathy’ in German by Hans Asperger.^[2][3] He distinguished his cases from autism which later became known as ‘Asperger’s Syndrome’.^[4] In 1981, Lorna Wing published Asperger’s works in English.^[5] In 1994, DSM-4 classified Asperger Syndrome (AS) as a subtype in the category of pervasive developmental disorders (PDD). In 2013, DSM-5 combined 4 of the 5 subtypes of pervasive developmental disorders (PDD) under the Autism Spectrum Disorder (ASD) category.^[6]

According to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5) released by the American Psychiatric Association (APA) in 2013, Asperger Syndrome (AS) is in the Autism Spectrum Disorder (ASD) category.^[1] Autism Spectrum Disorder (ASD) is a category of neurodevelopmental disorders in DSM-5 with problems in social communication/interaction, restricted and repetitive behaviors/interests.

The exact pathophysiology of Asperger Syndrome is unknown, however some neuroimaging and neuropsychological studies have reported some findings.^[7][8]

The exact cause of Asperger (AS) is unknown. Many factors including genetics, family history of autism spectrum disorders (ASD) and enviornmental factors such as older parental age, prematurity, low birth weight and pregnancy complications have been associated with autism spectrum disorder (ASD).^{[9][10][11][12][13][14][15]}

Prevalence rates for Asperger Syndrome ranges from 0.03 to 4.84 per 1,000 in different studies.^[2] In 2014, the overall prevalence of autism spectrum disorders (ASD) was estimated to be 16.8 per 1,000 children aged 8 years.^[16] The male to female prevalence ratio for ASD is approximately 4 to 1.^[16] The estimate for ASD prevalence was 7% and 22% higher among white children compared to black and Hispanic children respectively.^[16]

Several risk factors associated with Asperger Syndrome (AS) and austim spectrum disorder (ASD) are: male gender, older parental age, family history of austim spectrum disorder (ASD), prematurity, low birth weight and pregnancy complications.^{[16][12][11][10][17][15]}

Screening instruments for Asperger Syndrome include: Autism Screening Questionnaire (ASQ), Autism Spectrum Quotient (AQ), Autism Spectrum Screening uestionnaire (ASSQ) and diagnostic instruments for Asperger Syndrome include: Asperger Syndrome Diagnostic Scale (ASDS), Gilliam Asperger’s Disorder Scale (GADS) and Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI).^[8]

It is believed that 20% of Asperger Syndrome patients ‘grow out’ of their disorder and and do not meet the diagnostic criteria as adults, whereas many other patients improve.^[18] Diagnosis of AS is often delayed and sometimes done in adulthood.^[19] Social impairment is lifelong.^[20] Early diagnosis and intervention in patients with AS may improve adaptation and adjustment of the child.^[19] Asperger Syndrome (AS) is associated with several conditions such as attention deficit hyperactivity disorder (ADHD) (most common in pediatric patients)^[21], depression (most common in adolescent and adult patients)^[21][22] and anxiety disorders.^[22]

The Diagnostic Criteria for Autism Spectrum Disorder (ASD) released by the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) is used for the diagnosis of Asperger Syndrome (AS).^[1]

Several symptoms may be seen in Asperger Syndrome (AS) with impairments in social interaction, communication and restricted, repetitive behaviors and interests being the most important. There may be impairments in motor and sensory functions, speech, language and.sleep.

The most common clinical signs in Asperger Syndrome (AS) are impairments in social communication and repetitive behaviors.

Routine laboratory testing is not recommended.^[23]

Routine neuroimaging, electroencephalography (EEG) and genetic testing are not recommended in patients with Asperger Syndrome (AS).^[24][23]

Medical treatments used in Asperger Syndrome include: stimulants, a-2 adrenergic agonists, atypical antipsychotics, antidepressants and anticonvulsants. Many studies believe that medications alone can not improve Asperger Syndrome’s (AS) symptoms and other complementary interventions (social and behavioral) are required.^[25]

Behavioral therapies in Asperger Syndrome (AS) are used to help the patients with their social communication and to develop social skills.^[8]

Based on a prevalence of 1.1 % for autism spectrum disorder (ASD) in the US, the economic burden for ASD has been estimated to be $268.2991 billion (1.467% of GDP) and $460.8002 billion (1.649% of GDP) in 2015 and 2025 respectively.^[26]

There have been some experimental therapy and suggestions such as oxytocin and treatment with stem cells in patients with Asperger Syndrome (AS).^[25]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Asperger Syndrome (AS) is believed to be first described as ‘autistic psychopathy’ in German by Hans Asperger.^[1][2] He distinguished his cases from autism which later became known as ‘Asperger’s Syndrome’.^[3] In 1981, Lorna Wing published Asperger’s works in English.^[4] In 1994, DSM-4 classified Asperger Syndrome (AS) as a subtype in the category of pervasive developmental disorders (PDD). In 2013, DSM-5 combined 4 of the 5 subtypes of pervasive developmental disorders (PDD) under the Autism Spectrum Disorder (ASD) category.^[5]

• In 1938, Hans Asperger described ‘autistic psychopaths’ in German.^[1]
• In 1943, Leo Kanner described 11 cases with ‘infantile autism’ in his paper.^[6]
• In 1944, Hans Asperger, described four children with ‘autistic psychopathy’ in his thesis.^[2]
• Asperger used the term ‘autistic psychopathy’ to describe the cases in his studies and distinguished them from autism, which later were became known as ‘Asperger’s Syndrome’.^[3] 
• In 1981, Lorna Wing published Asperger’s works in English (translated from German).^[4]
• In 1991, Uta Frith translated Asperger’s thesis into English. Frith, Uta (1991). Autism and Asperger syndrome. Cambridge New York: Cambridge University Press. ISBN 978-0521386081.
• In 1994, DSM-4 classified Asperger Syndrome (AS) as a subtype in the category of pervasive developmental disorders (PDD).
• In 2013, DSM-5 combined 4 of the 5 subtypes of pervasive developmental disorders (PDD) under the Autism Spectrum Disorder (ASD) category.^[5]

Template:Pervasive developmental disorders

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

According to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5)^[1] released by the American Psychiatric Association (APA) in 2013, Asperger Syndrome (AS) is in the Autism Spectrum Disorder (ASD) category. Autism Spectrum Disorder (ASD) is a category of neurodevelopmental disorders in DSM-5 with problems in social communication/interaction, restricted and repetitive behaviors/interests.

According to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5)^[1] released by the American Psychiatric Association (APA) in 2013, Asperger Syndrome (AS) is in the Autism Spectrum Disorder (ASD) category. Autism Spectrum Disorder (ASD) is a category of neurodevelopmental disorders in DSM-5 with problems in social communication/interaction, restricted and repetitive behaviors/interests.

In DSM-IV, Asperger Syndrome (AS) was one of the 5 subtypes of Pervasive Developmental Disorder (PDD) category (which included: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Rett syndrome). In 2013, in DSM-5, a category called Autism Spectrum Disorder (ASD) was created by combining 4 of the 5 subtypes of DSM-IV’s Pervasive Developmental Disorder (PDD) category (autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified (PDD-NOS) and childhood disintegrative disorder).^[1][2]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

The exact pathophysiology of Asperger Syndrome is unknown, however some neuroimaging and neuropsychological studies have reported some findings.^[1][2]

Neuroimaging studies have shown structural and functional brain abnormalities in patients with Asperger (AS) such as:^[1][2]

• There has been a report on developmental problems of neuronal migration in the cerebral cortex during pregnancy and fetal development in patients with AS which may result in problems in the connectivity of the brain cortex.^[3]
• Smaller gray matter in the ventromedial aspect of the temporal lobe^[4] and bilateral caudate and left thalamus ^[5].
• Greater white matter around the basal ganglia and left inferior parietal lobe, but lower white matter volume in the right corpus callosum.^[6]
• Larger amygdala and hippocampal in patients with AS is associated to their difficulty with emotional reactivity^[7]
• Smaller anterior cingulate cortex (ACC) in AS patients is associated with their difficulty with self monitoring of behavior.^[7]
• Lesion in the white matter of the right middle temporal gyrus.^[8]
• Lower fractional anisotropy (FA) is seen mostly bilaterally and in the white matter (internal capsule, frontal, temporal, parietal and occipital lobe, cingulum and corpus callosum).^[9]
• Localized disconnection in cerebellar neural pathways may lead to abnormalities in adaptive social behavior.^[10]
• Abnormal functional connectivity of medial temporal lobe structures (amygdala and parahippocampus gyrus) is associated with difficulty in social cognition in AS patients.^[11]
• Abnormal dysactivation of the frontal lobe (during neuropsychological tests).^{[12][13][14][15]}
• Abnormal activation in the temporal cortex during face discrimination.^[16]
• Decreased activation of fusiform and extrastriate cortices during facial emotion processing.^[17]
• Executive dysfunctions are associated with abnormality in neural connectivity of the brain cortex.^[18]
• Neuroimaging patterns of AS patients were the same in static stimuli (photo of a face) and dynamic stimuli (real face).^[19]

Some chemical markers associated with AS include:^[1]

• Increase in N-acetyl aspartate/choline (NAA/Cho) level in the right anterior cingulate is associated with higher scores in obsessive compulsive scale in patients with AS.^[20]
• Increased in the activity of the presynaptic dopamine system in the striatum and frontal cortex in patients with AS.^[21]
• There is an association in cortical serotonin 5-HT2A receptor binding and social communication in patients with AS.^[22]
• Administration of oxytocin may improve emotion recognition, affective speech comprehension, increase eye gaze, and social interaction in patients with AS.^[23]

Neuropsychological abnormalities in AS are:^[2]

• Difficulty in passing theory of mind tasks
• Executive dysfunction
• Tendency to interpret visual stimuli in parts rather than wholes (poor central coherence)
• There are studies that suggest in patients with AS there is a Verbal IQ (VIQ) > Poor Performance IQ (PIQ) profile which shows strength on verbal skills relative to visuospatial skills and non-verbal problem solving (nonverbal learning disability)^[24]

Asperger Syndrome (AS) is associated with several conditions which include:

• Attention deficit hyperactivity disorder (ADHD) (most common in pediatric patients)^[25]
• Depression (most common in adolescent and adult patients)^[25][26]
• Bipolar disorder^[25][26]
• Tourette syndrome^[25]
• Obsessive compulsive disorder (OCD)^[25][26]
• Tic disorder^[25]
• Anxiety disorders^[26]
• Schizophrenia^[27] 
• Non-verbal learning disability^[28]
• Difficulty in falling asleep, sleepiness after awakening and during daytime and poor sleep quality^[29]
• There have been case-reports of Asperger Syndrome (AS) associated with aminoaciduria,^[30] ligamentous laxity^[31] and recurrent hypersomnia^[32].

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

The exact cause of Asperger (AS) is unknown. Many factors including genetics, family history of autism spectrum disorders (ASD) and enviornmental factors such as older parental age, prematurity, low birth weight and pregnancy complications have been associated with autism spectrum disorder (ASD).^{[1][2][3][4][5][6][7]}

• Linkage at 1q21-22^[1]
• Linkage at 13q31-33^[1]
• Linkage at 3p14–24^[1]
• Linkage at 3q21–24^[6]
• 17p breakpoints in t(13;17) and t(17;19)^[5]
• 3p22.1p21.31 microdeletion^[8]

Several studies suggest that a familial history of autism spectrum disorder (ASD) is a risk factor for Asperger Syndrome (AS).^[4][3][2]

Several environmental risk factors are associated with autism spectrum disorder (ASD) which include:^[7]

• Advanced maternal age
• Advanced paternal age
• Low birth weight
• Prematurity
• Hyperbilirubinemia, neonatal jaundice
• Maternal immigrant status  
• Pregnancy complications such as eclampsia and pregnancy-induced hypertension
• Air pollutants (traffic-related)
  

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

There are several differential diagnosis to consider in the diagnosis of Asperger Syndrome (AS) including attention deficit–hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), schizophrenia, schizoid personality disorder, schizotypal personality disorder and mood disorders.^[1][2]

• Conditions that must be considered in a differential diagnosis include:^[1][2]
  • Autism spectrum disorder (ASD)
  • Attention deficit–hyperactivity disorder (ADHD)
  • Obsessive compulsive disorder (OCD)
  • Schizophrenia
  • Schizophrenia simplex
  • Residual schizophrenia
  • Schizoid personality disorder
  • Schizotypal personality disorder
  • Semantic pragmatic disorder
  • Nonverbal learning disorder
  • Mood disorders (depression and anxiety)
  • Stereotypic movement disorder
  • Alexithymia
  • Avoidant personality disorder
  • Antisocial personality disorder
  • Borderline personality disorder
  • Narcissistic personality disorder
  • Nonverbal learning disorder
  • Post traumatic stress disorder (PTSD)
  • Social phobia
  • Compulsive (anankastic) personality disorder

• The following table shows the overlap of some differential diagnoses of AS that have abnormal social interaction:^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Prevalence rates for Asperger Syndrome ranges from 0.03 to 4.84 per 1,000 in different studies.^[1] In 2014, the overall prevalence of autism spectrum disorders (ASD) was estimated to be 16.8 per 1,000 children aged 8 years.^[2] The male to female prevalence ratio for ASD is approximately 4 to 1.^[2] The estimate for ASD prevalence was 7% and 22% higher among white children compared to black and Hispanic children respectively.^[2]

• Prevalence rates for Asperger Syndrome ranges from 0.03 to 4.84 per 1,000 in different studies.^[1]
• In 2014, the overall prevalence of autism spectrum disorders (ASD) was estimated to be 16.8 per 1,000 children aged 8 years.^[2]

• Males are more commonly affected by autism spectrum disorders (ASD) than females.^[2]
• The male to female ratio for ASD is approximately 4 to 1.^[2]

• In 2014, the estimate for ASD prevalence was 7% higher among white children compared to black children.^[2]
• In 2014, the estimate for ASD prevalence was 22% higher among white children compared to Hispanic children.^[2]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Several risk factors associated with Asperger Syndrome (AS) and austim spectrum disorder (ASD) are: male gender, older parental age, family history of austim spectrum disorder (ASD), prematurity, low birth weight and pregnancy complications.^{[1][2][3][4][5][6]}

Several risk factors have been associated with Asperger Syndrome:

• Male gender: The male to female ratio for austim spectrum disorder (ASD) is approximately 4 to 1.^[1]
• Family history of austim spectrum disorder (ASD)^[2][3][4]
• Race: AS has been reported to be 7% and 22% higher among white children compared to black and Hispanic children.^[5]
• Other risk factors associated with austim spectrum disorder (ASD) include:^[6]
  • Advanced maternal age
  • Advanced paternal age
  • Low birth weight
  • Prematurity
  • Hyperbilirubinemia, neonatal jaundice
  • Maternal immigrant status  
  • Pregnancy complications such as eclampsia and pregnancy-induced hypertension
  • Air pollutants (traffic-related)
    

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Screening instruments for Asperger Syndrome include: Autism Screening Questionnaire (ASQ), Autism Spectrum Quotient (AQ), Autism Spectrum Screening uestionnaire (ASSQ) and diagnostic instruments for Asperger Syndrome include: Asperger Syndrome Diagnostic Scale (ASDS), Gilliam Asperger’s Disorder Scale (GADS) and Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI).^[1]

• Early diagnosis and intervention in patients with AS may improve adaptation and adjustment of the child.^[2]
• Screening for associated disorders is an important prognostic factor.^[2]
• Screening instruments for Asperger Syndrome include:^[1]
  • Autism Screening Questionnaire (ASQ)
  • Autism Spectrum Quotient (AQ)
  • Autism Spectrum Screening Questionnaire (ASSQ)
• Diagnostic instruments for Asperger Syndrome include:^[1]
  • Asperger Syndrome Diagnostic Scale (ASDS)
  • Gilliam Asperger’s Disorder Scale (GADS)
  • Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI)  

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

It is believed that 20% of Asperger Syndrome patients ‘grow out’ of their disorder and and do not meet the diagnostic criteria as adults, whereas many other patients improve.^[1] Diagnosis of AS is often delayed and sometimes done in adulthood.^[2] Social impairment is lifelong.^[3] Early diagnosis and intervention in patients with AS may improve adaptation and adjustment of the child.^[2] Asperger Syndrome (AS) is associated with several conditions such as attention deficit hyperactivity disorder (ADHD) (most common in pediatric patients)^[4], depression (most common in adolescent and adult patients)^[4][5] and anxiety disorders^[5].

• It is believed that 20% of Asperger Syndrome patients ‘grow out’ of their disorder and and do not meet the diagnostic criteria as adults, whereas many other patients improve.^[1]  
• Diagnosis of AS is often delayed and sometimes done in adulthood.^[2]
• Social impairment is lifelong.^[3]
• Most attend regular education classes with additional support services.^[3]
• Some need special education services because of their social and behavioral impairments.^[3]
• Early diagnosis and intervention in patients with AS may improve adaptation and adjustment of the child.^[2].
• Screening for associated disorders is an important prognostic factor.^[2]

Asperger Syndrome (AS) is associated with several conditions which include:

• Attention deficit hyperactivity disorder (ADHD) (most common in pediatric patients)^[4]
• Depression (most common in adolescent and adult patients)^[4][5]
• Bipolar disorder^[4][5]
• Tourette Syndrome^[4]
• Obsessive compulsive disorder (OCD)^[4][5]
• Tic disorder^[4]
• Anxiety disorders^[5]
• Schizophrenia^[6] 
• Nonverbal learning disability^[7]
• Difficulty in falling asleep, sleepiness after awakening and during daytime and poor sleep quality^[8]
• There have been case-reports of Asperger Syndrome (AS) associated with aminoaciduria,^[9] ligamentous laxity^[10] and recurrent hypersomnia^[11].

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