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Asperger syndrome

Asperger's syndrome, a subspecies of autism, must have the following three symptoms, including: social difficulties, communication difficulties, and stubborn or narrow interests.

What is Asperger's Syndrome

Asperger Syndrome (AS) is a syndrome among pervasive developmental disorders (PDD). There are certain characteristics similar to autism (Autism, also known as autism), such as interpersonal communication difficulties, stereotyped and repetitive interests and behavior patterns, and therefore are also classified into the broader autism spectrum (Autism Spectrum Disorder, referred to as ASD) .

The clinical characteristics of Asperger's syndrome are generally described as:

1. Lack of understanding of other people's emotions.

2. Inappropriate and one-sided social interactions and lack of ability to establish friendships lead to social isolation.

3. Inflexible and monotonous language.

4. Poor non-verbal communication.

5. In some limited aspects, such as weather, TV program schedules, train timetables and maps, showing strong receptive ability, but only mechanically memorizing, but not understanding, giving People have strange impressions.

6. Clumsy, uncoordinated movements and strange postures.

Although most children have normal IQs, and a few even have high IQs in some areas, there are still a few who suffer from mild developmental delays. The disease tends to have overt onset, or at least detection, later than autism; therefore language and cognitive abilities are preserved. This situation is usually stable. And this higher IQ suggests a better long-term prognosis than autism.

There is currently no epidemiological survey of this disease in China. According to a survey of some kindergartens in a certain area in China, the incidence of the disease may be high, and the misdiagnosis rate of the disease is high.

The cause of Asperger syndrome

The cause of the disease is currently unknown. But research shows that genetics, biochemistry, viruses, problems during pregnancy and childbirth, and environmental issues may all be causes of Asperger syndrome. The probability of suffering from Asperger's syndrome is 0.07%, which means that on average, 7 out of every 10,000 newborns will be affected.

Symptoms of Asperger's syndrome

1. Qualitative impairment in social interaction

Isolation and inability to make friends: AS patients are usually Isolated and isolated, often contacting others with some unusual or strange behaviors. AS patients often desire and even try their best to establish connections with other people, but their clumsy communication skills and inability to understand other people's feelings and wishes (such as boredom, eagerness to leave, needs, privacy) prevent connections from being established.

Slow recognition and incomprehension of other people’s emotions: In terms of emotions in social communication, patients often show inappropriate reactions and incorrect interpretations during emotional communication, and are slow to respond to other people’s emotional expressions. , Understand rigidity or even indifference. Despite this, they have the ability to correctly describe other people's emotions in a cognitive and rigid manner.

Rigid and stubborn personality: The patient's behavioral reactions strongly rely on formulaic and rigid social behavioral norms and social rules, and cannot understand the intentions of others in an intuitive and spontaneous form, so they often show disjointed reactions. This performance leads to the strong impression that AS patients have childish and stereotyped social behavior.

2. Qualitative deficiencies in language communication

Although there is no significant functional impairment in this area in the definition of AS, there are at least three deficiencies in the language communication skills of AS. points are worth noting.

Inflexible language: Although the patient's morphological changes and intonation are not as monotonous and stereotyped as those with autism, the rhythm of the speech is poor, and the statement of facts and humorous comments often lack cadence.

Self-centered: Speech is often off-topic and incidental, giving people a sense of looseness and lack of internal connection and coherence. Although in some cases this symptom may indicate a thought disorder, more often the lack of coherence and interactivity in speech is the result of egocentric conversational patterns (e.g., unemotional comments about names). , a long monologue of numbers), fails to provide background information for the comments, fails to clearly define changes in the topic, and fails to refrain from expressing inner thoughts.

Talking to oneself without considering the wishes of the audience: The most typical feature of the patient's communication style is lengthy expressions. Some authors believe that this is the most obvious feature that distinguishes this disease from others. Patients will talk on and on about topics that interest them, regardless of whether the audience is interested or listening, wants to interrupt, or wants to change the topic.

3. Restricted, repetitive, and fixed patterns of behaviors, interests, and activities

What is most commonly observed in AS is a preoccupation with restricted interests. A sign of intense devotion to some unusual and very limited topics. Although this symptom is not easily recognized in childhood, this behavior is very special because the sufferer often learns super-normal knowledge about restricted topics (such as snakes, names of planets, maps, TV programs or railway timetables). An unusual amount of factual information.

4. Clumsy movements

This symptom is a symptom related to AS patients but not a basis for diagnosis, that is, delayed motor development and clumsy movements. People with AS may have a personal history of delayed development of motor skills, such as learning to ride a bicycle, catch a ball, open a can, etc. later than their peers. Usually they are inflexible, have a rigid gait, odd postures, poor operating skills, and significant deficits in visual-motor coordination.

Diagnosis of Asperger's syndrome

There is no laboratory test for Asperger's syndrome. It mainly requires observation and accumulation of mental behaviors in daily life, and pay attention to Whether there are any special symptoms, the diagnosis can be made according to the six requirements in symptom diagnosis. Generally, some different measurement tools need to be used, including the Asperger Diagnostic Scale (ASDS), the Autism Spectrum Disorder Screening Questionnaire (ASSQ), and the Childhood Asperger Syndrome Test (CAST). Because the characteristics of ASD are very different, doctors need to be able to tell the difference between ASD and other disorders. The definition of this disorder in DSM-IV (APA, 1994):

1. There is a disorder in social interaction. Qualitative judgment can only be made if at least two of the following conditions are present.

① There is a significant impairment in the ability to use some non-verbal behaviors for social communication, such as eye contact, facial expressions, body postures and gestures.

② Unable to establish appropriate partnerships commensurate with their age.

③Lack of desire to spontaneously seek out others to share happiness, hobbies or success.

④ Lack of communicative and emotional reciprocal behavior.

2. Stubbornly adhere to repetitive and unchanging patterns in behavior, preferences and activities, showing at least one of the following situations:

① Always in one or more situations A constant, limited pattern of interests, the intensity and concentration of which are abnormal.

② Obvious and stubborn insistence on some special and meaningless procedures and rituals.

③ Repeat and maintain some special habits that you have formed.

④ Pay attention to a part of the object for a long time.

3. The above-mentioned disorders seriously impair the child's functions in social interaction, occupation or other important areas.

4. There is no obvious clinically significant comprehensive delay in language development (for example, the child can speak a single word before the age of two, and knows how to use conversational phrases before the age of three).

5. There is no obvious clinically significant delay in the development of cognitive ability, self-care ability, adaptive behavior (except social aspects) and childhood curiosity about the external environment.

6. Does not meet other clear diagnostic criteria for pervasive developmental retardation and schizophrenia.

Treatment of Asperger's Syndrome

For the treatment of Asperger's Syndrome, the attitude that parents should give their children is mainly understanding, support, sympathy and tolerance. The cause of Asperger's syndrome is unknown, and there is no effective prevention method. The main treatment methods include behavior correction and social training. Special education services are necessary for such children.

Correction of abnormal behavior and training of social skills

For AS and other autism spectrum disorders, correction of abnormal behavior and training of social skills are currently the most mainstream treatments.

1. Self-support: Their social connections can be promoted by participating in various positive group activities (such as community services, fun clubs and self-support organizations). Recent empirical research shows that people with Asperger's syndrome enjoy communicating with other people with similar problems and can build relationships through activities or shared interests.

2. Adaptability: In any intervention plan, enabling patients to have sufficient abilities in all aspects should be a priority. The stereotyped characteristics of AS patients can be used to cultivate good habits and improve the quality of life of individuals and family members. Patient training methods should strictly follow the above guidelines and be performed routinely in diverse, naturalistic settings to maximize skill generalization.

3. Maladaptive behavior: Patients are usually trained in the form of verbal instructions to teach them special problem-solving methods to solve frequent and troublesome problems (such as novel, intense social requirements or frustrations in this regard). Training in this area is necessary to enable patients to understand the occurrence of problems and choose the best solution.

4. Social and communication skills: These skills may be best trained by sociologists with an interest in pragmatics. However, if social training institutions can provide patients with sufficient opportunities to contact trainers and practice special skills, they may also choose to receive training in them. Training tutorials should include the following aspects:

① Appropriate non-verbal behaviors (such as gazing in interactions with people and learning and imitating changes in pitch). These trainings include imitation training in front of the mirror, etc. etc.;

② Use language to explain other people’s non-verbal behaviors;

③ Process visual and auditory information simultaneously (to develop the ability to integrate multiple stimuli and enable the creation of appropriate social interactions (reduce the difficulty of relationship);

④ At the same time, cultivate and train patients’ social cognition and perspecive-talking skills, and correct their ambiguous expressions (such as non-literal language).

Psychotherapy

Although existing psychotherapy has not shown much effectiveness in treating AS, a certain degree of concentrated and structured counseling services can be beneficial to patients with AS, especially those with AS. It is of great help to patients who are sad, suffering from resistance, anxiety, family dysfunction or frustration.

Medication-Assisted Treatment

To date, there is no magic bullet for treating AS and the autism spectrum. Medications only have an auxiliary effect, mainly targeting some behavioral problems and mood disorders. In general, pharmacological intervention should be avoided as much as possible in children who develop debilitating depressive symptoms. Special medications may be given for severe delusions, obsessions, or confusion.

Common drugs and their effects include: methylphenidate can alleviate attention deficit hyperactivity disorder, clonidine can be used to treat combined hyperactive behavior and tic disorder, haloperidol can treat aggressive behavior, It can also reduce hyperactivity and stereotyped behaviors. Fluoxetine can improve patients' mood and depressive symptoms.

A detailed assessment plan needs to be established before treatment

Before starting every treatment and intervention plan, a comprehensive and thorough assessment is required to understand the child's deficiencies and existing abilities. ability.

A comprehensive assessment includes an assessment of previous and current behavioral (or mental) aspects, neurobiological functioning, communication patterns (especially the ability to use language to achieve some social purpose, or pragmatics), and adaptations. Sexual behavior (the ability to tap into one’s own potential to solve problems encountered in daily life).

Every child is different. It is therefore critical that intervention plans, based on comprehensive and extensive assessment, be tailored to the unique needs and abilities of the children to whom they are delivered.

Asperger syndrome and high-functioning autism

A popular saying is: Autistic people always live in their own world, while AS people live in their own world. Live in other people's world in your own way. But the difference between high-functioning people with autism and AS is even more subtle.

IQ

Generally, when defining Asperger's syndrome and high-functioning autism, an IQ of 70 or above is usually used as the range.

Ways of thinking

Most children with autism have special interests or special talents in certain things, such as mechanical counting abilities, mechanical musical abilities, and mechanical abilities. The ability to judge is not a thinking ability. Children with Asperger's syndrome are different. Children with Asperger's syndrome may always think about thoughtful questions such as "Why is the sky blue?" Compared with the mechanical special abilities unique to high-functioning autism, the special abilities of children with Asperger's syndrome are thinking.

Language fluency

People with high-functioning autism have very little spontaneous language and cannot express themselves fluently. Children with Asperger's syndrome have no problems with spontaneous speech and conversation. The problem is that during conversations, children with Asperger's syndrome will have "long conversations". Regardless of whether the other person is interested or not, they will keep talking about the same thing (such as something they are interested in), which can easily arouse the other person. resentment, which in turn affects their interpersonal interactions.

In terms of movement coordination

Children with high-functioning autism have no problem with large muscle movements, but children with Asperger's syndrome have very clumsy movements. They generally have difficulties with movement coordination. Four items:

1. Difficulty imitating body movements.

2. Unable to catch the ball smoothly.

3. Difficulty standing on one foot.

4. It is difficult to bend the ring fingers of both hands.

Social interaction

Unlike children with autism, children with Asperger's syndrome are capable, interested, and willing to participate, but because of their social intuition He is different from ordinary people, so he cannot understand the meaning of human interaction. For example, if you ask him to raise his right hand, he will raise his left hand. The reason is that he is facing the person giving the order and will imitate the person raising the same hand. Therefore, when teaching children with Asperger's syndrome, you should pay attention to their "reference points". Take teaching writing as an example. Don't write facing him, but go to his side and teach him to avoid the written words going up and down. on the contrary.

Aggression and violent behavior

Children with Asperger's syndrome have high moral standards and are therefore prone to conflicts in interactions. For example, when crossing the road, if they see someone running a red light, they will immediately stop them and say sternly: "No, call the police to arrest you!" If a similar situation occurs, it is easy to conflict with other people and be misunderstood for aggressive and violent behavior. Sometimes, they become aggressive or violent simply because they are "pushed".