What Causes Asperger's Syndrome?/All About Asperger's Syndrome

[A.J. Mahari]

What Causes Asperger's Syndrome?

Mechanism of autism

"Asperger syndrome appears to result from developmental factors that affect many or all functional brain systems, as opposed to localized effects.[27] Although the specific underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no clear pathology common to individuals with AS has emerged,[1] it is still possible that AS's mechanism is separate from other ASD.[28] Neuroanatomical studies and the associations with teratogens strongly suggest that the mechanism includes alteration of brain development soon after conception.[25] Abnormal migration of embryonic cells during fetal development may affect the final structure and connectivity of the brain, resulting in alterations in the neural circuits that control thought and behavior.[29] Several theories of mechanism are available; none are likely to be complete explanations.[30]
 
Functional magnetic resonance imaging provides some evidence for both underconnectivity and mirror neuron theories.[31][32]

The underconnectivity theory hypothesizes underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes.[31] It maps well to general-processing theories such as weak central coherence theory, which hypothesizes that a limited ability to see the big picture underlies the central disturbance in ASD.[33]

The mirror neuron system (MNS) theory hypothesizes that alterations to the development of the MNS interfere with imitation and lead to Asperger's core feature of social impairment.[32][34] For example, one study found that activation is delayed in the core circuit for imitation in individuals with AS.[35] This theory maps well to social cognition theories like the theory of mind, which hypothesizes that autistic behavior arises from impairments in ascribing mental states to oneself and others,[36] or hyper-systemizing, which hypothesizes that autistic individuals can systematize internal operation to handle internal events but are less effective at empathizing by handling events generated by other agents.[37]

Other possible mechanisms include serotonin dysfunction[38] and cerebellar dysfunction."[39]

Source: http://en.wikipedia.org/wiki/Asperger%27s_syndrome

[A.J. Mahari]

History of Asperger syndrome

"Named after the Austrian pediatrician Hans Asperger (1906–80), Asperger syndrome is a relatively new diagnosis in the field of autism.[70] In 1944, Asperger described four children in his practice[2] who had difficulty in integrating themselves socially. The children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Asperger called the condition "autistic psychopathy" and described it as primarily marked by social isolation.[4] Unlike today's AS, autistic psychopathy could be found in people of all levels of intelligence, including those with mental retardation.[71] He called his young patients "little professors",[72] and believed some would be capable of exceptional achievement and original thought later in life.[2] His paper was published during wartime and in German, so it was not widely read elsewhere.

Lorna Wing popularized the term Asperger syndrome in the English-speaking medical community in her 1981 publication[73] of a series of case studies of children showing similar symptoms,[70] and Uta Frith translated his paper to English in 1991.[72] Sets of diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari et al. in the same year.[66] AS became a standard diagnosis in 1992, when it was included in the tenth edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10); in 1994, it was added to the fourth edition of the American Psychiatric Association's diagnostic reference, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).[4]

Source: http://en.wikipedia.org/wiki/Asperger%27s_syndrome

Wing renewed interest in the condition, which she renamed Asperger syndrome, and described the following difficulties in the first 2 years of life of children with the condition:

• a lack of normal interest and pleasure in people around them;
• a reduction in the quality and quantity of babbling;
• a significant reduction in shared interests;
• a significant reduction in the wish to communicate verbally or non-verbally;
• a delay in speech acquisition and impoverishment of content;
• no imaginative play or imaginative play confined to one or two rigid patterns.

Source: http://apt.rcpsych.org/cgi/content/full/7/4/310

Hundreds of books, articles and websites now describe AS, and prevalence estimates have increased dramatically for ASD, with AS recognized as an important subgroup.[70] Whether it should be seen as distinct from high-functioning autism is a fundamental issue requiring further study.[2] There is little consensus among clinical researchers about the use of the term Asperger's syndrome, and there are questions about the empirical validation of the DSM-IV and ICD-10 criteria.[3]"

Source: http://en.wikipedia.org/wiki/Asperger%27s_syndrome

[A.J. Mahari]

Asperger syndrome also called Asperger's syndrome, Asperger's disorder, Asperger's or AS is one of several autism spectrum disorders (ASD) characterized by difficulties in social interaction and by restricted, stereotyped interests and activities. AS is distinguished from the other ASDs in having no general delay in language or cognitive development. Although not mentioned in standard diagnostic criteria, motor clumsiness and atypical use of language are frequently reported.[1][2]

Asperger syndrome was named after Hans Asperger who, in 1944, described children in his practice who lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Fifty years later, AS was recognized in the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger's Disorder. Questions about many aspects of AS remain: for example, there is lingering doubt about the distinction between AS and high-functioning autism (HFA);[3] partly due to this, the prevalence of AS is not firmly established. The exact cause of AS is unknown, although research supports the likelihood of a genetic contribution, and brain imaging techniques have identified structural and functional differences in specific regions of the brain.

There is no single treatment for Asperger syndrome, and the effectiveness of particular interventions is supported by only limited data. Intervention is aimed at improving symptoms and function. The mainstay of treatment is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and clumsiness. Most individuals with AS can learn to cope with their differences, but may continue to need moral support and encouragement to maintain an independent life.[4] Researchers and people with AS have contributed to a shift in attitudes away from the notion that AS is a deviation from the norm that must be treated or cured, and towards the view that AS is a difference rather than a disability.[5]"

Source: http://en.wikipedia.org/wiki/Asperger%27s_syndrome

[A.J. Mahari]

DSM-IV

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Below is the section of DSM-IV that deals with Pervasive Developmental Disorders.   In each section, it will refer to Criterion A, etc, to view the diagnostic criteria that they refer to, click on the each subtitle (i.e. 299.0 Autistic Disorder).


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Pervasive Developmental Disorders

Pervasive Developmental Disorders are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests, and activities. The qualitative impairments that define these conditions are distinctly deviant relative to the individual's developmental level or mental age. This section contains Autistic disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified. These disorders are usually evident in the first years of life and are often associated with some degree of Mental Retardation, which if present, should be coded on Axis II. The Pervasive Developmental Disorders are sometimes observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system). If such conditions are present, they should be noted on Axis III. Although terms like "psychosis" and "childhood schizophrenia" were once used to refer to individuals with these conditions, there is considerable evidence to suggest that the Pervasive Developmental Disorders are distinct from Schizophrenia (however, an individual with Pervasive Developmental Disorder may occasionally later develop Schizophrenia).

299.80 Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism)

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes atypical autism"--presentations that do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

299.80 Asperger's DisorderDiagnostic Features

The essential features of Asperger's Disorder are severe and sustained impairment in social interaction (Criterion A) and the development of restricted, repetitive patterns of behavior, interests, and activities (Criterion B) (see p. 66 in Autistic Disorder for a discussion of Criteria A and B). The disturbance must cause clinically significant impairment in social, occupational, or other important areas of functioning (Criterion C). In contrast to Autistic Disorder, there are no clinically significant delays in language (e.g., single words are used by age 2 years, communicative phrases are used by age 3 years) (Criterion D). In addition, there are no clinically significant delays in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood (Criterion E). The diagnosis is not given if the criteria are met for any other specific Pervasive Developmental Disorder or for Schizophrenia (Criterion F).

Associated Features and Disorders
Asperger's Disorder is sometimes observed in association with general medical conditions that should be coded on Axis III. Various nonspecific neurological symptoms or signs may be noted. Motor milestones may be delayed, and motor clumsiness is often observed.

Prevalence

Information on the prevalence of Asperger's Disorder is limited, but it appears to be more common in males.

Course

Asperger's Disorder appears to have a somewhat later onset than Autistic Disorder, or at least to be recognized somewhat later. Motor delays or motor clumsiness may be noted in the preschool period. Difficulties in social interaction may become more apparent in the context of school. It is during this time that particular idiosyncratic or circumscribed interests (e.g., a fascination with train schedules) may appear or be recognized as such. As adults, individuals with the condition may have problems with empathy and modulation of social interaction. This disorder apparently follows a continuous course and, in the vast majority of cases, the duration is lifelong.

Familial Pattern

Although the available data are limited, there appears to be an increased frequency of Asperger's Disorder among family members of individuals who have the disorder.

Differential Diagnosis

Asperger's Disorder is not diagnosed if criteria are met for another Pervasive Developmental Disorder or for Schizophrenia. For the differential diagnosis with Autistic Disorder, [see Autistic Disorder]. For the differential diagnosis with Rett's Disorder, [see Rett's Disorder]. For the differential diagnosis with Childhood Disintegrative Disorder, [see Childhood Disintegrative Disorder]. Asperger's Disorder must also be distinguished from Obsessive-Compulsive Disorder and Schizoid Personality Disorder. Asperger's Disorder and Obsessive-Compulsive Disorder share repetitive and stereotyped patterns of behavior. In contrast to Obsessive-Compulsive Disorder, Asperger's Disorder is characterized by a qualitative impairment in social interaction and a more restricted pattern of interests and activities. In contrast to Schizoid Personality Disorder, Asperger's Disorder is characterized by stereotyped behaviors and interests and by more severely impaired social interaction.

[A.J. Mahari]

INFORMATION SHEET

Age Group: Children / Adolescents and Young Adults / Adults
Sheet Title: Diagnosis of Asperger’s Syndrome

If parents, teachers or carers notice that the person in their care shows signs of
difficulties in certain areas it is essential to seek a professional diagnosis.
Lorna Wing (Burgoine & Wing 1983) described the main clinical features of
Asperger’s Syndrome as:

• Lack of empathy
• Naive, inappropriate, one-sided interaction
• Little or no ability to form friendships
• Pedantic, repetitive speech
• Poor non-verbal communication
• Intense absorption in certain subjects
• Clumsy and ill-coordinated movements and odd postures

Whilst diagnosis of Asperger’s Syndrome in children is more common, many people
are not diagnosed until adulthood.

Dr Tony Attwood says: “It must be emphasised that none of the diagnostic
characteristics of Asperger’s Syndrome are unique, and it is unusual to find a person
who has a severe expression of every characteristic”.

The initial stage should be for parents to consult their GP to get a referral to a specialist.

There can be two stages leading to a diagnosis of Asperger’s Syndrome:

• 1) This involves parents or teachers completing a questionnaire or rating scale
  that can be used to indicate a child who might have the syndrome (see
  Australian Scale of Diagnosis Information Sheet).
• 2) This is a diagnostic assessment by clinicians experienced in examining the
  behaviour and abilities of children with developmental disorders, using
  established criteria that give a clear description of the syndrome.

The overwhelming majority of referrals for a diagnostic assessment for Asperger’s Syndrome are boys.

Tony Attwood has put forward suggestions why girls are less likely to be identified as having characteristics indicative of Asperger’s Syndrome. (see The Pattern of Abilities and Development of Girls with Asperger’s Syndrome Information Sheet).

WHAT TO EXPECT:

Once you are referred to a specialist, you will be given a diagnostic assessment.
This can take half a day to a fully day and consists of an examination of specific
aspects of social, language, cognitive and movement skills, as well as qualitative
aspects of the child’s interests. There may also be some formal testing using a
range of psychological tests. Time is also spent with the parents, to obtain
information regarding developmental history and behaviour in specific situations.
Another invaluable source of information is reports from teachers and speech and
occupational therapists.

It is also essential for the specialist to consider alternative diagnoses and
explanations. Social withdrawal and immature social play can be a secondary
consequence of a language disorder.

For example, if a child were diagnosed with classic Autism as a young child, it is
essential that this diagnosis be regularly reviewed to examine whether Asperger’s
Syndrome is now a more accurate diagnosis and the child should receive
appropriately designed services.

A person with Asperger’s Syndrome may have progressed through the primary
school years as a somewhat eccentric or reclusive child, but not have any signs that
would indicate referral for a diagnostic assessment.

However, as a teenager, the person may become more aware of their social
isolation and try to become more sociable. Their attempts to join in the social
activities of their peers are met with ridicule and exclusion, causing the person to be
depressed. The depression can lead to a diagnosis of Asperger’s Syndrome.
Many young adults with Asperger’s Syndrome report intense feelings of anxiety, and
this may reach a level where treatment is required. During adolescence, the person
may retreat into their own inner world, talking to themselves and losing interest in
social contact and personal hygiene.

When conducting a diagnostic assessment of adults, it is very important to obtain
reliable information on the person’s abilities and behaviour as a child. Parents,
relatives or teachers can be a source of invaluable knowledge to support the adult’s
recollection of their childhood.

The teenage and young adult years are a time of stress and complication for all
people, so be prepared for a person with AS to find it very difficult to understand and
accept at first. Often, when a person with AS is older than this, and has never been
diagnosed, it comes as a huge relief and explanation to them when they discover
that they have AS. It is not always so when you are in the midst of the already
complicated teenage years.

Asperger’s Syndrome Foundation, The Kensington Charity Centre, 4th Floor, Charles House, 375 Kensington High Street, London, W14 8QH
Email: info@aspergerfoundation.org.uk
A Charity and Company limited by guarantee, registered in England and Wales. Company number: 4288005 Registered Charity number: 1090785.
ALL OUR INFORMATION SHEETS CAN BE FOUND AT WWW.ASPERGERFOUNDATION.ORG.UK

[A.J. Mahari]

INFORMATION SHEET

Age Group: Adults
Sheet Title: Depression or Mental Health Problems

People with Asperger’s Syndrome are particularly vulnerable to mental health
problems such as anxiety and depression, especially in late adolescence and early
adult life.

However, the inability of people with Asperger’s Syndrome to communicate feelings
of disturbance, anxiety or distress can also mean that it is often very difficult to
diagnose a depressed or anxious state, particularly for clinicians who have little
knowledge or understanding of developmental disorders.

Similarly, because of their impairment in non-verbal expression, they may not
appear to be depressed. This can mean that it is not until the illness is welldeveloped
that it is recognised, with possible consequences such as total
withdrawal; increased obsessional behaviour; refusal to leave the home, go to work
or college, etc, and threatened, attempted or actual suicide. Aggression, paranoia or
alcoholism may also occur.

In treating mental illness in the patient with Asperger’s Syndrome, it is important that
the psychiatrist or other health professional has knowledge of the individual being
assessed.

It is crucial that the physician involved is fully informed about the individual’s usual
style of communication, both verbal and non-verbal. In particular it is recommended,
if possible, that they speak to the parents or carers to ensure that the information
received is reliable, e.g. any recent changes from the normal pattern of behaviour.
Psychiatrists should be aware of the signs of Asperger’s Syndrome as they appear
in adolescents and adults if diagnostic errors are to be avoided.

Treatments for anxiety and depression that are effective for people without
Asperger’s Syndrome are also effective for people with Asperger’s Syndrome.

Depression

Depression is common in individuals with Asperger’s Syndrome. People with
Asperger’s Syndrome leaving home and going to college frequently report feelings
of depression.

Depression in people with Asperger’s Syndrome may be related to a growing
awareness of their disability or a sense of being different from their peer group
and/or an inability to form relationships or take part in social activities successfully.
Personal accounts by young people with Asperger’s Syndrome frequently refer to
attempts to make friends but "I just did not know the rules of what you were or were
not supposed to do". Indeed, some people have even been accused of harassment
in their attempts to socialise, something that can only add to their depression and
anxiety.

The difficulties people with Asperger’s Syndrome have with personal space can
compound this sort of problem. For example, they may stand too close or too far
from the person to whom they are speaking.

Other precipitating factors are also seen in many people without Asperger’s
Syndrome who are depressed and include: loneliness, bereavement or other form of
loss, sexual frustration, a constant feeling of failure, extreme anxiety levels, etc.
Childhood experiences such as bullying or abuse may also result in depression, as
can a history of misdiagnosis. Another possibility is that the person is biologically
predisposed to depression. However, there are, of course, many other factors that
may trigger the depression and this list should not be taken as exhaustive.
Depression in someone with Asperger’s Syndrome might show itself through a
particular preoccupation or obsession, and care must be taken to ensure that the
depression is not diagnosed as schizophrenia or some other psychotic disorder or
just put down to Asperger’s Syndrome.

It is important to assess the individual’s depression in the context of their Asperger’s
Syndrome, i.e.: their social disabilities, and any gradual or sudden changes in
behaviour, sleep patterns, anger or withdrawal should always be taken seriously.

Symptoms of depression can be:

• Psychological (poor concentration/memory, thoughts of death or suicide,
tearfulness)
• Physical (slowing down or agitation, tiredness/lack of energy, sleep problems,
disturbed appetite)
• Motivational – also affecting mood (low mood, loss of interest or pleasure,
hopelessness, helplessness, worthlessness, withdrawal or bizarre beliefs).
People with depression can also experience periods of mania.

Three approaches need to be made in diagnosing depression in a person with
Asperger’s Syndrome:

1. Deterioration in cognition, language, behaviour or activity. The complaint is
rarely couched in terms of mood.
2. It is important to take the patient’s history to establish their baseline, patterns
of activity and interests. It is this pattern with which the presenting patterns can
be compared.
3. An attempt should be made to assess the patient’s mental state, both directly
and through the parent or carer, if present. Examples would include reports of
crying, difficulties in separating from their parent/carer for an interview,
increased/ decreased activity, agitation or aggression.

There may be evidence of new or increased self-injury or worsening autistic
features, such as increased proportion of echolalia or the reappearance of handflapping.
Some people with Asperger’s Syndrome also have difficulty in expressing
appropriate and subtle emotions. They may, for example, laugh or giggle in
circumstances where other people would show embarrassment, discomfort, pain or
sadness. It is stressed that this unusual reaction, for example, after bereavement,
does not mean the person is being callous or is mentally ill.

They need understanding and tolerance of their idiosyncratic way of expressing their grief.

In treating depression, medications used in general practice may be prescribed. It is
important to realise, however, that such agents do not make an impact on the
primary social impairments that underlie Asperger’s Syndrome.
As with any treatment for depression, adjustments may have to be made to find the
appropriate drug and dosage for that particular person. Side effects should also be
monitored and effort made to ensure the benefits of the treatment outweigh the
penalties.

It is also important to identify the cause for the depression and this may involve
counselling, social skills training, or meeting up with people with similar interests and
values.

Anxiety

Anxiety is a common problem in people with Asperger’s Syndrome.

It has been found that 84.1% of children with pervasive developmental disorder met
the full criteria of at least one anxiety disorder (phobia, panic disorder, separation
anxiety disorder, avoidant disorder, overanxious disorder, obsessive compulsive
disorder).

This does not necessarily go away as the child grows older. Many young adults with
Asperger’s Syndrome report intense feelings of anxiety, an anxiety that may reach a
level where treatment is required. For some people, it is the treatment of their
anxiety disorder that leads to a diagnosis of Asperger’s Syndrome.

People with Asperger’s Syndrome are particularly prone to anxiety disorders as a
consequence of the social demands made upon them. Any social contact can
generate anxiety as to how to start, maintain and end the activity and conversation.
Changes to daily routine can exacerbate the anxiety, as can certain sensory
experiences.

One way of coping with their anxiety levels is for persons with Asperger’s Syndrome
to retreat into their particular interest. Their level of preoccupation can be used a
measure of their degree of anxiety. The more anxious the person, the more intense
the interest.

Anxiety can also increase the rigidity in thought processes and insistence upon
routines. Thus, the more anxious the person, the greater the expression of their
Asperger’s Syndrome. When happy and relaxed, it may not be anything like as
apparent.

One potentially good way of managing anxiety is to use behavioural techniques. For
children, this may involve teachers or parents looking out for recognised symptoms,
such as rocking or hand-flapping, as an indication that the child is anxious.
Adults and older children can be taught to recognise these symptoms themselves,
although some might need prompting. Specific events may also be known to trigger
anxiety e.g. a stranger entering the room. When certain events (internal or external)
are recognised as a sign of imminent or increasing anxiety, action can be taken. For
example, relaxation, distraction or physical activity.

The choice of relaxation method depends very much on the individual and many of
the relaxation products available commercially can be adapted for use for people
with Asperger’s Syndrome.

Young children may respond to watching their favourite video. Older children and
adults may prefer to listen to calming music. There is much music on the market,
both from specialist outfits and regular music stores, that is written specifically to
bring about a feeling of tranquillity.

It is important the person does not have social demands, however slight, made upon
them if they are to benefit. It is also important that they have access to a quiet room.
Other techniques include massage (this should be administered carefully to avoid
sensory defensiveness), aromatherapy, deep breathing and using positive thoughts.
It has been suggested that the use of photographs, postcards or pictures of a
pleasant or familiar scene can help. These need to be small enough to be carried
about and should be laminated in order to protect them.

It is also stressed that there is a vital need to practice whichever method of
relaxation is chosen at frequent and regular intervals, in order for it to be of any
practical use when anxieties actually arise.

An alternative option, particularly if the person is very agitated, is to undertake a
physical activity. Activities may include using the swing or trampoline, going for a
long walk perhaps with the dog, or doing physical chores around the home.
Whatever method is chosen to reduce anxiety, it is crucial to identify the cause of
the anxiety. This should be done by careful monitoring of the precedents to an
increase in anxiety and the source of the anxiety tackled.

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is described as a condition characterised by
recurring, obsessive thoughts (obsessions) or compulsive actions (compulsions).
Obsessive thoughts are ideas, pictures of thoughts or impulses, which repeatedly
enter the mind, whereas compulsive actions and rituals are behaviours which are
repeated over and over again.

It is thought that the stereotypic obsessive action seen in children with Asperger’s
Syndrome differs from the child with OCD. The child with Asperger’s Syndrome
does not have the ability to put things into perspective.
Although terminology implies that certain behaviours in Asperger’s Syndrome are
similar to those seen in OCD, these behaviours fail to meet the definition of either
obsessions or compulsions. They are not invasive, undesired or annoying, a
prerequisite for a diagnosis of OCD. The reason for this is that people with (severe)
Asperger’s Syndrome are unable to contemplate or talk about their own mental
states.

However, OCD does appear often to coincide with Asperger’s Syndrome, although
there is very little literature examining the relationship between the two.
People with Asperger’s Syndrome can sometimes respond to conventional
behavioural treatment to help reduce the symptoms of OCD. However, as with
anyone, this will only be effective if the person wants to stop their obsessions. An
alternative is use medication to reduce the anxiety around the obsessions, thus
enabling the person to tolerate the frustration of not carrying out their obsession.

Schizophrenia

There is no evidence that people with autistic conditions are any more likely than
anyone else to develop schizophrenia.

It is also important to realise that people have been diagnosed as having
schizophrenia when, in fact, they have Asperger’s Syndrome. This is because their
odd behaviour or speech pattern, or the persons strange accounts or interpretations
of life, are seen as a sign of mental illness, such as schizophrenia. Obsessional
thoughts can become quite bizarre during mood swings and these can be seen as
evidence of schizophrenia rather than the mood disorder that actually are.

Psychological Treatments

A primary psychological treatment for mood disorders is Cognitive Behavioural
Therapy, as it is effective in changing the way a person thinks and responds to
feelings such as anxiety, sadness and anger, addressing any deficits and distortions
in thinking.

This therapy can be adapted for use with people with Asperger’s Syndrome:

• have a clear structure, e.g. protocols of turn-taking
• adapt the length of sessions. Therapy might have to be very brief, e.g. 10-15 minutes long
• the therapy must be non-interpretative
• the therapy must not be anxiety provoking as any arousal of emotion during therapy may be very counterproductive
• group therapy should not be used

It is also important that the therapist has a working knowledge and understanding of
Asperger’s Syndrome in a counselling setting, i.e. the difficulty people with AS have
dealing with things emotionally, finding it best to deal with things intellectually.
The therapist and client can work towards explicit operational goals, the focus being
on concrete and specific symptoms.

Asperger’s Syndrome Foundation, The Kensington Charity Centre, 4th Floor, Charles House, 375 Kensington High Street, London, W14 8QH
Email: info@aspergerfoundation.org.uk
A Charity and Company limited by guarantee, registered in England and Wales. Company number: 4288005 Registered Charity number: 1090785.
ALL OUR INFORMATION SHEETS CAN BE FOUND AT WWW.ASPERGERFOUNDATION.ORG.UK

[A.J. Mahari]

INFORMATION SHEET

Age Group: Adults
Sheet Title: Tony Attwood’s Anger Management Plan

Reasons for Anger Episodes Experienced by People with Asperger’s Syndrome:

* A limited ability to manage negative feelings, especially frustration
* A lack of empathy and self control to moderate their reaction
* A perception of anger as a solution to problems (negative reinforcement)
* Immature conflict resolution skills
* A limited vocabulary to express negative emotions
* A tendency to literal interpretation, which can lead to problems
* Impaired theory of mind skills and apparent paranoia
* An authoritarian nature
* Being set up by others (live theatre)
* The externalisation of agitated depression
* A thought or emotion ‘tic’ (as with Tourette Syndrome)
* A Dr. Jekyll and Mr. Hyde character
* A need to target those closest to them
* An intolerance of imperfection and people being inconsistent
* An anger that is intense but brief
* A lack of anger memory

Treatment of Anger for People with Asperger’s Syndrome

* Try and find and participate in a social skills project on anger
* Use a mental “Angermometer” to grade the level of anger felt
* Try to put the event in perspective
* Use relaxation techniques
* Learn self-talk methods
* Check all the information surrounding an incident
* Use rescue phrases (and then seek help and disclose the feelings)
* Consider the consequences

Asperger’s Syndrome Foundation, The Kensington Charity Centre, 4th Floor, Charles House, 375 Kensington High Street, London, W14 8QH
Email: info@aspergerfoundation.org.uk
A Charity and Company limited by guarantee, registered in England and Wales. Company number: 4288005 Registered Charity number: 1090785.
ALL OUR INFORMATION SHEETS CAN BE FOUND AT WWW.ASPERGERFOUNDATION.ORG.UK

[A.J. Mahari]

INFORMATION SHEET

Age Group: Adults
Sheet Title: Issues for Partners of Asperger’s Syndrome Adults

Responsibility

Most partners often feel very responsible for their husband/wife. It is important to
acknowledge that there is choice connected to that responsibility. You are not
responsible. If you choose to take on responsibility for others, decide on how much
and when you feel it is appropriate.

Look after yourself

Often partners spend so much time looking after others, that their own needs are not
acknowledged by themselves or others. Decide what you want and how you can get
it. For example, where can you go for conversation, support etc. Take time out to
pamper yourself - whatever helps to relieve your stress.

Talking to someone who understands

Asperger’s Syndrome is a complex condition, and it is important that support is
informed and understanding of these complexities. The benefit in talking to
someone who understands should not be under-estimated.

Acceptance

Acknowledging that your partner will "not get better", or be transformed into the
person you thought they were, can sometimes help, although this is also difficult.
Certain behaviour can be modified or changed, which can make daily life less
stressful for both you and your partner. For example, routines and agreed timetables
can help, as can looking at how you talk and what language is used.

With acceptance of the condition come a range of other issues, such as grief and
the realisation of what is not going to be. For some, there will be a feeling of
disappointment, loss and unfulfilled potential. Talking to a counsellor can really help
- they can listen and enable you to explore the issues, emotions and choices.

Isolation

You are not alone, although it may often feel as though this is the case.
Professionals are getting better at recognising the condition and developing
appropriate service - although this will often seem too slow for many needing help
now. Use what help is available, through a partner support group and/or counselling.

Look at your domestic routine

Try and see what structures may help and what may hinder. For example it may be
important to agree how meal times will be conducted (e.g. sitting down together at
the table). To be rigid on all times (e.g. we will eat at 6pm), may be more difficult if
you cannot always meet the schedule - dinner at 6.15pm may cause stress to both
of you.

Be clear and explicit about what you want

Do not leave ambiguity in your statements, and do not assume your
wishes/emotions are acknowledged and understood. For example it may not be
enough to remind your partner that you have family over for a meal. You may need
to go through the evening in detail, explaining what you want him to do, and not do,
e.g. greet everyone once, and do not go to bed before the guests leave.

Ending the relationship

This is an option. It is important to get legal advice so that you understand the
financial and practical implications of separation. Many solicitors will offer a free ½
hour initial appointment, and your local Citizens Advice Bureau can often give help.
Advice from a legal professional is exactly that - it does not mean you have to leave;
it can just help eliminate the unknown. Counselling can be helpful to enable you
come to a decision; your local Relate Centre will be listed in Yellow pages.

Asperger’s Syndrome Foundation, The Kensington Charity Centre, 4th Floor, Charles House, 375 Kensington High Street, London, W14 8QH
Email: info@aspergerfoundation.org.uk
A Charity and Company limited by guarantee, registered in England and Wales. Company number: 4288005 Registered Charity number: 1090785.
ALL OUR INFORMATION SHEETS CAN BE FOUND AT WWW.ASPERGERFOUNDATION.ORG.UK

[A.J. Mahari]

INFORMATION SHEET

Age Group: Children / Adolescents and Young Adults
Sheet Title: Tony Attwood's Paper on Girls

The Pattern of Abilities and Development of Girls with Asperger’s Syndrome

Dr. Tony Attwood - September 1999

The overwhelming majority of referrals for a diagnostic assessment for Asperger’s
Syndrome are boys. The ratio of males to females is around 10:1, yet the
epidemiological research for Autistic Spectrum Disorders suggests that the ratio
should be 4:1. Why are girls less likely to be identified as having the characteristics
indicative of Asperger’s Syndrome? The following are some tentative suggestions
that have yet to be validated by academic research, but they provide some plausible
explanations based on preliminary clinical experience.

• It appears that many girls with Asperger’s Syndrome have the same profile of
abilities as boys but a subtler or less severe expression of the characteristics.
Parents may be reluctant to seek a diagnostic assessment if the child appears
to be coping reasonably well and clinicians may be hesitant to commit
themselves to a diagnosis unless the signs are conspicuously different to the
normal range of behaviour and abilities.

• We have a stereotype of typical female and male behaviour. Girls are more
able to verbalise their emotions and less likely to use physically aggressive
acts in response to negative emotions such as confusion, frustration and
anger. We do not know whether this is a cultural or constitutional
characteristic but we recognise that children who are aggressive are more
likely to be referred for a diagnostic assessment to determine whether the
behaviour is due to a specific developmental disorder and for advice on
behaviour management. Hence boys with Asperger’s Syndrome are more
often referred to a psychologists or psychiatrist because their aggression has
become a concern for their parents or schoolteacher. A consequence of this
referral bias is that not only are more boys referred, clinicians and academics
can have a false impression of the incidence of aggression in this population.

• One must always consider the personality of the person with Asperger’s
Syndrome and how they cope with the difficulties they experience in social
reasoning, empathy and cognition. Some individuals are overtly active
participants in social situations. Their unusual profile of abilities in social
situations is quite obvious. However, some are reluctant to socialise with
others and their personality can be described as passive. They can become
quite adept at camouflaging their difficulties and clinical experience suggests
that the passive personality is more common in girls.

• Each person with Asperger’s Syndrome develops their own techniques and
strategies to learn how to acquire specific skills and develop coping
mechanisms. One technique is to have practical guidance and moral support
from one’s peers. We know that children with Asperger’s Syndrome elicit from
others, either strong maternal or ‘predatory’ behaviour. If the person’s natural
peer group is girls, they are more likely to be supported and included by a
greater majority of their peers. Thus girls with Asperger’s Syndrome are often
‘mothered’ by other girls. They may prompt the child when they are unsure
what to do or say in social situations and comfort them when they are
distressed. In contrast, boys are notorious for their intolerance of children who
are different and are more prone to be ‘predatory’. This can have an
unfortunate effect on the behaviour of a boy with Asperger’s Syndrome and
many complain of being teased, ignored and bullied by other boys. It is
interesting to note that some boys with Asperger’s Syndrome actually prefer
to play with girls who are often kinder and more tolerant than their male peers.

• The author has conducted both individual and group social skills training with
boys and girls with Asperger’s Syndrome. Experience has indicated that, in
general, the girls are more motivated to learn and quicker to understand key
concepts in comparison to boys with Asperger’s Syndrome of equivalent
intellectual ability. Thus, they may have a better long-term prognosis in terms
of becoming more fluent in their social skills. This may explain why women
with Asperger’s Syndrome are often less conspicuous than men with the
syndrome and less likely to be referred for a diagnostic assessment. The
author has also noted that, in general, mothers with Asperger’s Syndrome
appear to have more ‘maternal’ and empathic abilities with their own children
than men with Asperger’s Syndrome, who can have great difficulty
understanding and relating to their children.

• Some individuals with Asperger’s Syndrome can be quite ingenious in using
imitation and modelling to camouflage their difficulties in social situations. One
strategy that has been used by many girls and some boys is to observe
people who are socially skilled and to copy their mannerisms, voice and
persona. This is a form of social echolalia or mirroring where the person
acquires a superficial social competence by acting the part of another person.
This is illustrated in Liane Holliday-Willeys intriguing new autobiography, titled,
"Pretending to be Normal".

I could take part in the world as an observer. I was an avid observer. I was
enthralled with the nuances of people’s actions. In fact, I often found it desirable to
become the other person. Not that I consciously set out to do that, rather it came as
something I simply did. As if I had no choice in the matter. My mother tells me I
was very good at capturing the essence and persona of people. At times I literally
copied someone’s looks and their actions. I was uncanny in my ability to copy
accents, vocal inflections, facial expressions, hand movements, gaits and tiny
gestures. It was as if I became the person I was emulating. (p.22)

Girls are more likely to be enrolled in speech and drama lessons and this provides
an ideal and socially acceptable opportunity for coaching in body language. Many
people with Asperger’s Syndrome have a prodigious memory and this can include
reciting the dialogue for all characters in a play and memorising the dialogue or
‘script’ of real life conversations. Knowing the script also means the child does not
have to worry about what to say. Acting can subsequently become a successful
career option although there can be some confusion when adults with Asperger’s
Syndrome act another persona in real life as this can be misconstrued as Multiple
Personality Disorder rather than a constructive means of coping with Asperger’s
Syndrome.

• When a child would like more friends but clearly has little success in this
area, one option is to create imaginary friends. This often occurs with young
girls who visualise friends in their solitary play or use dolls as a substitute
for real people. Girls with Asperger’s Syndrome can create imaginary
friends and elaborate doll play which superficially resembles the play of
other girls but there can be several qualitative differences. They often lack
reciprocity in their natural social play and can be too controlling when
playing with their peers. This is illustrated in Liane Holliday-Willey’s
autobiography.

The fun came from setting up and arranging things. Maybe this desire to organise
things rather than play with things, is the reason I never had a great interest in my
peers. They always wanted to use the things I had so carefully arranged. They
would want to rearrange and redo. They did not let me control the environment.
When involved with solitary play with dolls, the girl with Asperger’s Syndrome
has total control and can script and direct the play without interference and having to
accept outcomes suggested by others. The script and actions can be an almost
perfect reproduction of a real event or scene from a book or film. While the special
interest in collecting and playing with dolls can be assumed to be an age appropriate
activity and not indicative of psychopathology, the dominance and intensity of the
interest is unusual. Playing with and talking to imaginary friends and dolls can also
continue into the teenage years when the person would have been expected to
mature beyond such play. This quality can be misinterpreted as evidence of
hallucinations and delusions and a diagnostic assessment for schizophrenia rather
than Asperger’s Syndrome.

• The most popular special interests of boys with Asperger’s Syndrome are
types of transport, specialist areas of science and electronics, particularly
computers. It has now become a more common reaction of clinicians to
consider whether a boy with an encyclopaedic knowledge in these areas
has Asperger’s Syndrome. Girls with Asperger’s Syndrome can be
interested in the same topics but clinical experience suggests their special
interest can be animals and classic literature. These interests are not
typically associated with boys with Asperger’s Syndrome. The interest in
animals can be focussed on horses or native animals and this characteristic
dismissed as simply typical of young girls. However, the intensity and
qualitative aspects of the interest are unusual. Teenage girls with
Asperger’s Syndrome can also develop a fascination with classic literature
such as the plays of Shakespeare and poetry. Both have an intrinsic rhythm
that they find entrancing and some develop their writing skills and
fascination with words to become a successful author, poet or academic in
English literature. Some adults with Asperger’s Syndrome are now
examining the works of famous authors for indications of the unusual
perception and reasoning associated with Asperger’s Syndrome. One
example is the short story, “Cold” in ‘Elementals: Stories of Fire and Ice’ by
A.S. Byatt.

• Finally, the author has noted that some ladies with Asperger’s Syndrome
can be unusual in their tone of voice. Their tone resembles a much younger
person, having an almost child like quality. Many are concerned about the
physiological changes during puberty and prefer to maintain the
characteristics of childhood. As with boys with Asperger’s Syndrome, they
may see no value in being fashionable, preferring practical clothing and not
using cosmetics or deodorants. This latter characteristic can be quite
conspicuous.

These tentative explanations for the apparent under representation of girls with
Asperger’s Syndrome have yet to be examined by objective research studies. It is
clear that we need more epidemiological studies to establish the true incidence in
girls and for research on the clinical signs, cognitive abilities and adaptive behaviour
to include an examination of any quantitative and qualitative differences between
male and female subjects. In the meantime, girls with Asperger’s Syndrome are
likely to continue to be overlooked and not to receive the degree of understanding
and resources they need.

Reference:

Holliday-Willey, L. (1999) Pretending to be Normal: Living with Asperger’s
Syndrome. London. Jessica Kingsley Publications.

© Dr. Tony Attwood

[A.J. Mahari]

INFORMATION SHEET

Age Group: Children / Adolescents and Young Adults / Adults
Sheet Title: Sensory Issues

A significant number of people with Asperger’s Syndrome have been perceived to
display either an over-sensitivity or an under-sensitivity to sensory stimuli. This
includes all, or a combination of: touch, taste, smell, sound, sight and movement, as
well as possible problems with motor co-ordination.

One or several sensory systems are affected such that ordinary sensations are
perceived as unbearably intense. The mere anticipation of the experience can lead
to intense anxiety or panic.

Fortunately, the hyper-sensitivity can diminish during later childhood, but for some
individuals it may continue throughout their lives.

AUDIO SENSITIVITY

It has been observed that there are three types of noise that are perceived as
extremely intense:

? Sudden, unexpected noises (a dog barking, a telephone ringing, someone
coughing or the clicking of a pen top)
? High-pitched, continuous noise (small electric motors used in kitchen,
bathroom or garden equipment)
? Confusing, complex or multiple sounds (in shopping centres or noisy social
gatherings)

It can be hard to understand that these auditory stimuli can cause such pain, but an
example of what it may feel like is the discomfort many people feel when they hear
fingernails scraping down a school blackboard. The mere thought of this sound can
make some people shiver.

One of the features of the acute sound sensitivity is the degree and variation of
sensitivity. On some days the sounds are perceived as unbearably intense, while
on others they are annoying but tolerable.

Some people with Asperger’s Syndrome learn to “switch off” or tune out certain
sounds. Techniques include doodling, humming or focusing intently on a particular
object.

Thus, inattention or odd distressed behaviour may be a reaction to sounds that the
teacher or parent would consider insignificant.

A person with AS can keep silicone ear-plugs on their person, ready to insert them if
noise levels become unbearable.

Music can also be used to camouflage the disturbing noises. Having the opportunity
to listen to music several times a day can significantly reduce abnormal responses
to sound.

It helps to explain the cause and duration of the unbearable sound by using Carol
Gray’s Social Stories. To know that the hand-dryer in a public toilet will switch off
automatically after a set time can help enormously.

TACTILE SENSITIVITY

There can be an extreme sensitivity to a particular intensity of touch or touching
particular parts of the body.

For some people with Asperger’s Syndrome, the forms of touch used in social
greetings or gestures of affection were perceived as too intense or overwhelming.

Particular areas of the body appear to be more sensitive, namely the scalp, upper
arms and palms. This may cause panic at a hairdresser or when it is time to have
hair washed or combed. Some children hate handling certain textures, such as
finger paints or playdough. There can also be a reluctance to wear a variety of
clothing.

It may be that the child will insist upon having a limited wardrobe to ensure
consistency of tactile experience. Once a particular garment is tolerated, it may be
necessary to buy several of increasing size, to cope with washing and the growth of
the child.

Fortunately, Occupational Therapists have developed treatment programmes called
Sensory Integration Therapy and these may help to reduce the tactile sensitivity.
These therapies include massage, gentle rubbing of the area and vibration.
Sometimes deep pressure and vestibular stimulation (rocking or spinning) can help.

SENSITIVITY TO THE TASTE AND TEXTURE OF FOOD

Some young children with Asperger’s Syndrome are thought to be extremely fussy
in their choice of food. Fortunately, most children with Asperger’s Syndrome who
have this type of sensitivity eventually grow out of it.

It is important to avoid programmes of force feeding or starvation to encourage a
more varied diet. This is not a behavioural problem, where the child is being
deliberately defiant, but a physiological reaction.

However, it is important for parents to ensure that the child eats an appropriate
range of food, and a dietician may provide guidance on what is nutritious but
tolerable to the child in terms of texture and taste.

Gradually, the sensitivity diminishes, but the fear and consequent avoidance may
continue. When this occurs, the child can be encouraged to lick and taste rather
than chew or swallow new food in order to encourage variety and to test their
sensory reaction.

It is also a good idea to give the child the opportunity to try new food when relaxed
or distracted.

VISUAL SENSITIVITY

Another characteristic of Asperger’s Syndrome is sensitivity to particular levels of
illumination, colours or a distortion of visual perception.

Some people with AS report being “blinded by brightness” and avoid intense levels
of illumination. It is therefore a good idea to seat the child with AS away from the
sunny window, etc. Another approach is to use sunglasses, photo chromic lenses
and sun visors indoors to avoid intense light or glare. It has been noted that some
adults with AS find IRLEN LENSES to be beneficial in reducing visual sensitivity.

The intense perception of colours can be recognised in the paintings of some people
with AS.

Another characteristic is perceptual distortion, which can lead to a small space being
perceived as even smaller by the person with AS, which can lead to fear or anxiety.
It is hard to know how to reduce this visual sensitivity. In time effective strategies
may be discovered, but at present we can only identify the problems and try to avoid
them.

SENSITIVITY TO SMELL

Some people with Asperger’s Syndrome report that specific smells can be
overpowering. Changes in perfume and household cleaning fluids can be perceived
as extremely pungent and may have to be avoided.

SENSITIVITY TO PAIN AND TEMPERATURE

It may appear that the person with Asperger’s Syndrome is very brave, and not
showing any response to levels of pain that others would consider unbearable.
It is as if the person with AS has a broken internal pain and temperature thermostat.
Because of this, the person with AS may not learn to avoid certain dangerous
actions, causing frequent trips to casualty. Medical staff may be surprised at the
frequency of the visits, and consider the parents negligent. Obviously, it is important
to explain that the child has sensory issues related to Asperger’s Syndrome.
It is also difficult for the person with AS to detect when they need medical help. Ear
infections or appendicitis may progress to a dangerous level before being detected.
If a child with AS shows minimal response to pain, it is essential for the parents to
be vigilant for any signs of discomfort or unusual behaviour which may lead to the
discovery of an illness.

It is important to explain to the child why reporting pain is important.

SYNAESTHESIA

This is when a person experiences a sensation in one sensory system and as a
result experiences a sensation in another modality. The most common expression
is seeing colours every time a person hears a particular sound. This is sometimes
called coloured hearing.

It has also been noted that sometimes auditory stimuli interfered with other sensory
processes, e.g. it is necessary to turn of kitchen appliances so that something can
be tasted.

STRATEGIES IN BRIEF

AUDITORY SENSITIVITY

? Avoid some sounds
? Listening to music can camouflage the sound
? Auditory integration training may be helpful
? Minimise the background noise, especially several people talking at the same time
? Consider using earplugs

TACTILE SENSITIVITY

? Buy several duplicates of tolerated garments
? Sensory Integration Therapy may be helpful
? Areas can be de-sensitised using massage and vibration

SENSITIVITY TO TASTE & TEXTURE OF FOOD

? Avoid force-feeding or starvation programmes
? Only lick and taste new food rather than chew or swallow
? Try new food when distracted or relaxed

VISUAL SENSITIVITY

? Avoid intense level of light
? Use a sun visor or sunglasses

SENSITIVITY TO PAIN

? Look for behavioural indicators of pain
? Encourage the child to report pain
? Minor discomfort may indicate a significant illness
? Explain to the child why reporting pain is important

Asperger’s Syndrome Foundation, The Kensington Charity Centre, 4th Floor, Charles House, 375 Kensington High Street, London, W14 8QH
Email: info@aspergerfoundation.org.uk
A Charity and Company limited by guarantee, registered in England and Wales. Company number: 4288005 Registered Charity number: 1090785.
ALL OUR INFORMATION SHEETS CAN BE FOUND AT WWW.ASPERGERFOUNDATION.ORG.UK

[A.J. Mahari]

DIFFERENCES BETWEEN ASDS  
 
Autism-spectrum disorders afflict 1 in 150 8-year-olds, according to government figures. Most children with ASDs have been identified by that age. People who have all five ASDs demonstrate poor social interaction and communication skills and repetitive behavior or interests. The severity of these deficits varies from disorder to disorder.

Autism

Accompanied by mental retardation in 70% of cases. Delay or abnormal functioning in social interaction, language or imaginative play is evident by age 3.

Asperger's syndrome

Symptoms are typically milder. No "clinically significant" delay in language or "cognitive development." Speech may lack inflection or be too formal.

Pervasive developmental disorder not otherwise specified (PDD-NOS)

"Subthreshold" condition in which some, but not all, features of autism or Asperger's are identified.

Rett syndrome

Affecting 1 in 10,000-15,000 females. At 6-18 months, autism-like symptoms become apparent, including characteristic hand-wringing. The child's mental and social development regresses.

Childhood disintegrative disorder

Occurs in 2 in 100,000 children with ASDs. Average onset is between ages 3 and 4; regression is usually more dramatic than in Rett syndrome.


Sources: Autism clinic at the University of California-San Francisco; Diagnostic and Statistical Manual of Mental Disorders IV; National Institute of Mental Health; Autism Society of America
 

[A.J. Mahari]

The Geek Syndrome

Autism - and its milder cousin Asperger's syndrome - is surging among the children of Silicon Valley. Are math-and-tech genes to blame?

By Steve Silberman

Nick is building a universe on his computer. He's already mapped out his first planet: an anvil-shaped world called Denthaim that is home to gnomes and gods, along with a three-gendered race known as kiman. As he tells me about his universe, Nick looks up at the ceiling, humming fragments of a melody over and over. "I'm thinking of making magic a form of quantum physics, but I haven't decided yet, actually," he explains. The music of his speech is pitched high, alternately poetic and pedantic - as if the soul of an Oxford don has been awkwardly reincarnated in the body of a chubby, rosy-cheeked boy from Silicon Valley. Nick is 11 years old.

Nick's father is a software engineer, and his mother is a computer programmer. They've known that Nick was an unusual child for a long time. He's infatuated with fantasy novels, but he has a hard time reading people. Clearly bright and imaginative, he has no friends his own age. His inability to pick up on hidden agendas makes him easy prey to certain cruelties, as when some kids paid him a few dollars to wear a ridiculous outfit to school.

One therapist suggested that Nick was suffering from an anxiety disorder. Another said he had a speech impediment. Then his mother read a book called Asperger's Syndrome: A Guide for Parents and Professionals. In it, psychologist Tony Attwood describes children who lack basic social and motor skills, seem unable to decode body language and sense the feelings of others, avoid eye contact, and frequently launch into monologues about narrowly defined - and often highly technical - interests. Even when very young, these children become obsessed with order, arranging their toys in a regimented fashion on the floor and flying into tantrums when their routines are disturbed. As teenagers, they're prone to getting into trouble with teachers and other figures of authority, partly because the subtle cues that define societal hierarchies are invisible to them.

"I thought, 'That's Nick,'" his mother recalls.

Asperger's syndrome is one of the disorders on the autistic spectrum - a milder form of the condition that afflicted Raymond Babbitt, the character played by Dustin Hoffman in Rain Man. In the taxonomy of autism, those with Asperger's syndrome have average - or even very high - IQs, while 70 percent of those with other autistic disorders suffer from mild to severe mental retardation. One of the estimated 450,000 people in the US living with autism, Nick is more fortunate than most. He can read, write, and speak. He'll be able to live and work on his own. Once he gets out of junior high hell, it's not hard to imagine Nick creating a niche for himself in all his exuberant strangeness. At the less fortunate end of the spectrum are what diagnosticians call "profoundly affected" children. If not forcibly engaged, these children spend their waking hours in trancelike states, staring at lights, rocking, making high-pitched squeaks, and flapping their hands, repetitively stimulating ("stimming") their miswired nervous systems.

In one of the uncanny synchronicities of science, autism was first recognized on two continents nearly simultaneously. In 1943, a child psychiatrist named Leo Kanner published a monograph outlining a curious set of behaviors he noticed in 11 children at the Johns Hopkins Hospital in Baltimore. A year later, a pediatrician in Vienna named Hans Asperger, who had never seen Kanner's work, published a paper describing four children who shared many of the same traits. Both Kanner and Asperger gave the condition the same name: autism - from the Greek word for self, autòs - because the children in their care seemed to withdraw into iron-walled universes of their own.

Kanner went on to launch the field of child psychiatry in the US, while Asperger's clinic was destroyed by a shower of Allied bombs. Over the next 40 years, Kanner became widely known as the author of the canonical textbook in his field, in which he classified autism as a subset of childhood schizophrenia. Asperger was virtually ignored outside of Europe and died in 1980. The term Asperger syndrome wasn't coined until a year later, by UK psychologist Lorna Wing, and Asperger's original paper wasn't even translated into English until 1991. Wing built upon Asperger's intuition that even certain gifted children might also be autistic. She described the disorder as a continuum that "ranges from the most profoundly physically and mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality."

Asperger's notion of a continuum that embraces both smart, geeky kids like Nick and those with so-called classic or profound autism has been accepted by the medical establishment only in the last decade. Like most distinctions in the world of childhood developmental disorders, the line between classic autism and Asperger's syndrome is hazy, shifting with the state of diagnostic opinion. Autism was added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980, but Asperger's syndrome wasn't included as a separate disorder until the fourth edition in 1994. The taxonomy is further complicated by the fact that few if any people who have Asperger's syndrome will exhibit all of the behaviors listed in the DSM-IV. (The syn in syndrome derives from the same root as the syn in synchronicity - the word means that certain symptoms tend to cluster together, but all need not be present to make the diagnosis.) Though Asperger's syndrome is less disabling than "low-functioning" forms of autism, kids who have it suffer difficulties in the same areas as classically autistic children do: social interactions, motor skills, sensory processing, and a tendency toward repetitive behavior.

In the last 20 years, significant advances have been made in developing methods of behavioral training that help autistic children find ways to communicate. These techniques, however, require prodigious amounts of persistence, time, money, and love. Though more than half a century has passed since Kanner and Asperger first gave a name to autism, there is still no known cause, no miracle drug, and no cure.

And now, something dark and unsettling is happening in Silicon Valley.

In the past decade, there has been a significant surge in the number of kids diagnosed with autism throughout California. In August 1993, there were 4,911 cases of so-called level-one autism logged in the state's Department of Developmental Services client-management system. This figure doesn't include kids with Asperger's syndrome, like Nick, but only those who have received a diagnosis of classic autism. In the mid-'90s, this caseload started spiraling up. In 1999, the number of clients was more than double what it had been six years earlier. Then the curve started spiking. By July 2001, there were 15,441 clients in the DDS database. Now there are more than seven new cases of level-one autism - 85 percent of them children - entering the system every day.

Through the '90s, cases tripled in California. "Anyone who says this is due to better diagnostics has his head in the sand."

California is not alone. Rates of both classic autism and Asperger's syndrome are going up all over the world, which is certainly cause for alarm and for the urgent mobilization of research. Autism was once considered a very rare disorder, occurring in one out of every 10,000 births. Now it's understood to be much more common - perhaps 20 times more. But according to local authorities, the picture in California is particularly bleak in Santa Clara County. Here in Silicon Valley, family support services provided by the DDS are brokered by the San Andreas Regional Center, one of 21 such centers in the state. SARC dispenses desperately needed resources (such as in-home behavioral training, educational aides, and respite care) to families in four counties. While the autistic caseload is rising in all four, the percentage of cases of classic autism among the total client population in Santa Clara County is higher enough to be worrisome, says SARC's director, Santi Rogers.

"There's a significant difference, and no signs that it's abating," says Rogers. "We've been watching these numbers for years. We feared that something like this was coming. But this is a burst that has staggered us in our steps."

It's not easy to arrive at a clear picture of whether there actually is a startling rise in the incidence of autism in California, as opposed to just an increase in diagnoses. One problem, says Linda Lotspeich, director of the Stanford Pervasive Developmental Disorders Clinic, is that "the rules in the DSM-IV don't work." The diagnostic criteria are subjective, like "Marked impairment in the use of nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction."

"How much 'eye-to-eye gaze' do you have to have to be normal?" asks Lotspeich. "How do you define what 'marked' is? In shades of gray, when does black become white?"

Some children will receive a diagnosis of classic autism, and another diagnosis of Asperger's syndrome, from two different clinicians. Tony Attwood's advice to parents is strictly practical: "Use the diagnosis that provides the services."

While diagnostic fuzziness may be contributing to a pervasive sense that autism is on the rise, Ron Huff, the consulting psychologist for the DDS who uncovered the statistical trend, does not believe that all we're seeing now is an increase in children who would have previously been tagged with some other disability, such as mental retardation - or overlooked as perfectly healthy, if quirky, kids.

"While we certainly need to do more research," says Huff, "I don't think the change in diagnostic criteria will account for all of this rise by any means."

The department is making its data available to the MIND Institute at the University of California at Davis, to tease out what's behind the numbers. The results of that research will be published next year. But the effects of a surging influx are already rippling through the local schools. Carol Zepecki, director of student services and special education for the Palo Alto Unified School District, is disturbed by what she's seeing. "To be honest with you, as I look back on the special-ed students I've worked with for 20 years, it's clear to me that these kids would not have been placed in another category. The numbers are definitely higher." Elizabeth Rochin, a special-ed teacher at Cupertino High, says local educators are scrambling to create new resources. "We know it's happening, because they're coming through our schools. Our director saw the iceberg approaching and said, 'We've got to build something for them.'"

The people scrambling hardest are parents. In-home therapy alone can cost $60,000 or more a year, and requires so much dedication that parents (particularly mothers) are often forced to quit their jobs and make managing a team of specialists their new 80-hour-a-week career. Before their children become eligible for state funding, parents must obtain a diagnosis from a qualified clinician, which requires hours of testing and observation. Local facilities, such as the Stanford Pervasive Development Disorders Clinic and its counterpart at UC San Francisco, are swamped. The Stanford clinic is able to perform only two or three diagnoses a week. It currently has a two- to six-month waiting list.

For Rick Rollens, former secretary of the California Senate and cofounder of the MIND Institute, the notion that there is a frightening increase in autism worldwide is no longer in question. "Anyone who says this epidemic is due to better diagnostics," he says, "has his head in the sand."

Autism's insidious style of onset is particularly cruel to parents, because for the first two years of life, nothing seems to be wrong. Their child is engaged with the world, progressing normally, taking first steps into language. Then, suddenly, some unknown cascade of neurological events washes it all away.

One father of an autistic child, Jonathan Shestack, describes what happened to his son, Dov, as "watching our sweet, beautiful boy disappear in front of our eyes." At two, Dov's first words - Mom, Dad, flower, park - abruptly retreated into silence. Over the next six months, Dov ceased to recognize his own name and the faces of his parents. It took Dov a year of intensive behavioral therapy to learn how to point. At age 9, after the most effective interventions available (such as the step-by-step behavioral training methods developed by Ivar Lovaas at UCLA), Dov can speak 20 words.

[A.J. Mahari]

The Geek Syndrome (Continued)

Even children who make significant progress require levels of day-to-day attention from their families that can best be described as heroic. Marnin Kligfeld is the founder of a software mergers-and-acquisitions firm. His wife, Margo Estrin, a doctor of internal medicine, is the daughter of Gerald Estrin, who was a mentor to many of the original architects of the Internet (see "Meet the Bellbusters," Wired 9.11, page 164). When their daughter, Leah, was 3, a pediatrician at Oakland Children's Hospital looked at her on the examining table and declared, "There is very little difference between your daughter and an animal. We have no idea what she will be able to do in the future." After eight years of interventions - behavioral training, occupational therapy, speech therapy - Leah is a happy, upbeat 11-year-old who downloads her favorite songs by the hundreds. And she is still deeply autistic.

Leah's first visit to the dentist required weeks of preparation, because autistic people are made deeply anxious by any change in routine. "We took pictures of the dentist's office and the staff, and drove Leah past the office several times," Kligfeld recalls. "Our dentist scheduled us for the end of the day, when there were no other patients, and set goals with us. The goal of the first session was to have Leah sit in the chair. The second session was so Leah could rehearse the steps involved in treatment without actually doing them. The dentist gave all of his equipment special names for her. Throughout this process, we used a large mirror so Leah could see exactly what was being done, to ensure that there were no surprises."

Daily ordeals like this, common in the autistic community, underline the folly of the hypothesis that prevailed among psychologists 20 years ago, who were convinced that autism was caused by a lack of parental affection. The influential psychiatrist Bruno Bettelheim aggressively promoted a theory that has come to be known as the "refrigerator mother" hypothesis. He declared in his best-selling book, The Empty Fortress, "The precipitating factor in infantile autism is the parent's wish that his child should not exist. ... To this the child responds with massive withdrawal." He prescribed "parentectomy" - removal of the child from the parents - and years of family therapy. His hypothesis added the burden of guilt to the grief of having an autistic child, and made autism a source of shame and secrecy, which hampered efforts to obtain clinical data. The hypothesis has been thoroughly discredited. Richard Pollak's The Creation of Dr. B exposed Bettelheim as a brilliant liar who concocted case histories and exaggerated both his experience with autistic children and the success of his treatments.

One thing nearly everyone in the field agrees on: genetic predisposition. Identical twins share the disorder 9 times out of 10.

But the debates about the causes of autism are certainly not over. Controversies rage about whether environmental factors - such as mercury and other chemicals in universally administered vaccines, industrial pollutants in air and water, and even certain foods - act as catalysts that trigger the disorder. Bernard Rimland, the first psychologist to oppose Bettelheim and promote the idea that autism was organic in origin, has become a leading advocate for intensified investigation in this area. The father of an autistic son, Rimland has been instrumental in marshaling medical expertise and family data to create better assessment protocols.

The one thing that almost all researchers in the field agree on is that genetic predisposition plays a crucial role in laying the neurological foundations of autism in most cases. Studies have shown that if one identical twin is autistic, there's a 90 percent chance that the other twin will also have the disorder. If parents have had one autistic child, the risk of their second child being autistic rises from 1 in 500 to 1 in 20. After two children with the disorder, the sobering odds are 1 in 3. (So many parents refrain from having more offspring after one autistic child, geneticists even have a term for it: stoppage.) The chances that the siblings of an autistic child will display one or more of the other developmental disorders with a known genetic basis - such as dyslexia or Tourette's syndrome - are also significantly higher than normal.

The bad news from Santa Clara County raises an inescapable question. Unless the genetic hypothesis is proven false, which is unlikely, regions with a higher than normal distribution of people on the autistic spectrum are something no researcher could ask for: living laboratories for the study of genetic expression. When the rain that fell on the Rain Man falls harder on certain communities than others, what becomes of the children?

The answer may be raining all over Silicon Valley. And one of the best hopes of finding a cure may be locked in the DNA sequences that produced the minds that have made this area the technological powerhouse of the world.

It's a familiar joke in the industry that many of the hardcore programmers in IT strongholds like Intel, Adobe, and Silicon Graphics - coming to work early, leaving late, sucking down Big Gulps in their cubicles while they code for hours - are residing somewhere in Asperger's domain. Kathryn Stewart, director of the Orion Academy, a high school for high-functioning kids in Moraga, California, calls Asperger's syndrome "the engineers' disorder." Bill Gates is regularly diagnosed in the press: His single-minded focus on technical minutiae, rocking motions, and flat tone of voice are all suggestive of an adult with some trace of the disorder. Dov's father told me that his friends in the Valley say many of their coworkers "could be diagnosed with ODD - they're odd." In Microserfs, novelist Douglas Coupland observes, "I think all tech people are slightly autistic."

Though no one has tried to convince the Valley's best and brightest to sign up for batteries of tests, the culture of the area has subtly evolved to meet the social needs of adults in high-functioning regions of the spectrum. In the geek warrens of engineering and R&D, social graces are beside the point. You can be as off-the-wall as you want to be, but if your code is bulletproof, no one's going to point out that you've been wearing the same shirt for two weeks. Autistic people have a hard time multitasking - particularly when one of the channels is face-to-face communication. Replacing the hubbub of the traditional office with a screen and an email address inserts a controllable interface between a programmer and the chaos of everyday life. Flattened workplace hierarchies are more comfortable for those who find it hard to read social cues. A WYSIWYG world, where respect and rewards are based strictly on merit, is an Asperger's dream.

Obviously, this kind of accommodation is not unique to the Valley. The halls of academe have long been a forgiving environment for absentminded professors. Temple Grandin - the inspiring and accomplished autistic woman profiled in Oliver Sacks' An Anthropologist on Mars - calls NASA the largest sheltered workshop in the world.

A recurring theme in case histories of autism, going all the way back to Kanner's and Asperger's original monographs, is an attraction to highly organized systems and complex machines. There's even a perennial cast of hackers: early adopters with a subversive streak. In 1944, Asperger wrote of a boy "chemist [who] uses all his money for experiments which often horrify his family and even steals to fund them." Another boy proved a mathematical error in Isaac Newton's calculations while he was still a freshman in college. A third escaped neighborhood bullies by taking lessons from an old watchmaker. And a fourth, wrote Asperger, "came to be preoccupied with fantastic inventions, such as spaceships and the like." Here he added, "one observes how remote from reality autistic interests really are" - a comment he qualified years later, when spaceships were no longer remote or fantastic, by joking that the inventors of spaceships might themselves be autistic.

Clumsy and easily overwhelmed in the physical world, autistic minds soar in the virtual realms of mathematics, symbols, and code. Asperger compared the children in his clinic to calculating machines: "intelligent automata" - a metaphor employed by many autistic people themselves to describe their own rule-based, image-driven thought processes. In her autobiography, Thinking in Pictures, Grandin compares her mind to a VCR. When she hears the word dog, she mentally replays what she calls "videotapes" of various dogs that she's seen, to arrive at something close to the average person's abstract notion of the category that includes all dogs. This visual concreteness has been a boon to her work as a designer of more humane machinery for handling livestock. Grandin sees the machines in her head and sets them running, debugging as she goes. When the design in her mind does everything it's supposed to, she draws a blueprint of what she sees.

"In another age, these men would have been monks, developing new ink for printing presses. Suddenly, they're reproducing at a much higher rate."

These days, the autistic fascinations with technology, ordered systems, visual modes of thinking, and subversive creativity have plenty of outlets. There's even a cheeky Asperger's term for the rest of us - NTs, "neurotypicals." Many children on the spectrum become obsessed with VCRs, Pokémon, and computer games, working the joysticks until blisters appear on their fingers. (In the diagnostic lexicon, this kind of relentless behavior is called "perseveration.") Even when playing alongside someone their own age, however, autistic kids tend to play separately. Echoing Asperger, the director of the clinic in San Jose where I met Nick, Michelle Garcia Winner, suggests that "Pokémon must have been invented by a team of Japanese engineers with Asperger." Attwood writes that computers "are an ideal interest for a person with Asperger's syndrome ... they are logical, consistent, and not prone to moods."

This affinity for computers gives teachers and parents leverage they can use to build on the natural strengths of autistic children. Many teenagers who lack the motor skills to write by hand find it easier to use a keyboard. At Orion Academy, every student is required to buy an iBook fitted with an AirPort card. Class notes are written on electronic whiteboards that port the instructional materials to the school server for retrieval. (At lunch, the iBooks are shut off, and if the kids want to play a two-person game, they're directed to a chess board.) The next generation of assistive technology is being designed by Neil Scott's Archimedes Project at Stanford. Scott's team is currently developing the equivalent of a PDA for autistic kids, able to parse subtle movements of an eyebrow or fingertip into streams of text, voice, or images. The devices will incorporate video cameras, head and eye tracking, intelligent agents, and speech recognition to suit the needs of the individual child.

The Valley is a self-selecting community where passionately bright people migrate from all over the world to make smart machines work smarter. The nuts-and-bolts practicality of hard labor among the bits appeals to the predilections of the high-functioning autistic mind. The hidden cost of building enclaves like this, however, may be lurking in the findings of nearly every major genetic study of autism in the last 10 years. Over and over again, researchers have concluded that the DNA scripts for autism are probably passed down not only by relatives who are classically autistic, but by those who display only a few typically autistic behaviors. (Geneticists call those who don't fit into the diagnostic pigeonholes "broad autistic phenotypes.")

[A.J. Mahari]

The Geek Syndrome (Continued)

The chilling possibility is that what's happening now is the first proof that the genes responsible for bestowing certain special gifts on slightly autistic adults - the very abilities that have made them dreamers and architects of our technological future - are capable of bringing a plague down on the best minds of the next generation. For parents employed in prominent IT firms here, the news of increased diagnoses of autism in their ranks is a confirmation of rumors that have quietly circulated for months. Every day, more and more of their coworkers are running into one another in the waiting rooms of local clinics, taking the first uncertain steps on a journey with their children that lasts for the rest of their lives.

In previous eras, even those who recognized early that autism might have a genetic underpinning considered it a disorder that only moved diagonally down branches of a family tree. Direct inheritance was almost out of the question, because autistic people rarely had children. The profoundly affected spent their lives in institutions, and those with Asperger's syndrome tended to be loners. They were the strange uncle who droned on in a tuneless voice, tending his private logs of baseball statistics or military arcana; the cousin who never married, celibate by choice, fussy about the arrangement of her things, who spoke in a lexicon mined reading dictionaries cover to cover.

The old line "insanity is hereditary, you get it from your kids" has a twist in the autistic world. It has become commonplace for parents to diagnose themselves as having Asperger's syndrome, or to pinpoint other relatives living on the spectrum, only after their own children have been diagnosed.

High tech hot spots like the Valley, and Route 128 outside of Boston, are a curious oxymoron: They're fraternal associations of loners. In these places, if you're a geek living in the high-functioning regions of the spectrum, your chances of meeting someone who shares your perseverating obsession (think Linux or Star Trek) are greatly expanded. As more women enter the IT workplace, guys who might never have had a prayer of finding a kindred spirit suddenly discover that she's hacking Perl scripts in the next cubicle.

One provocative hypothesis that might account for the rise of spectrum disorders in technically adept communities like Silicon Valley, some geneticists speculate, is an increase in assortative mating. Superficially, assortative mating is the blond gentleman who prefers blondes; the hyperverbal intellectual who meets her soul mate in the therapist's waiting room. There are additional pressures and incentives for autistic people to find companionship - if they wish to do so - with someone who is also on the spectrum. Grandin writes, "Marriages work out best when two people with autism marry or when a person marries a handicapped or eccentric spouse.... They are attracted because their intellects work on a similar wavelength."


That's not to say that geeks, even autistic ones, are attracted only to other geeks. Compensatory unions of opposites also thrive along the continuum, and in the last 10 years, geekitude has become sexy and associated with financial success. The lone-wolf programmer may be the research director of a major company, managing the back end of an IT empire at a comfortable remove from the actual clients. Says Bryna Siegel, author of The World of the Autistic Child and director of the PDD clinic at UCSF, "In another historical time, these men would have become monks, developing new ink for early printing presses. Suddenly they're making $150,000 a year with stock options. They're reproducing at a much higher rate."

Genetic hypotheses like these don't rule out environmental factors playing a role in the rising numbers. Autism is almost certainly not caused by the action of a single gene, but by some orchestration of multiple genes that may make the developing child more susceptible to a trigger in the environment. One consequence of increased reproduction among people carrying some of these genes might be to boost "genetic loading" in successive generations - leaving them more vulnerable to threats posed by toxins in vaccines, candida, or any number of agents lurking in the industrialized world.

At clinics and schools in the Valley, the observation that most parents of autistic kids are engineers and programmers who themselves display autistic behavior is not news. And it may not be news to other communities either. Last January, Microsoft became the first major US corporation to offer its employees insurance benefits to cover the cost of behavioral training for their autistic children. One Bay Area mother told me that when she was planning a move to Minnesota with her son, who has Asperger's syndrome, she asked the school district there if they could meet her son's needs. "They told me that the northwest quadrant of Rochester, where the IBMers congregate, has a large number of Asperger kids," she recalls. "It was recommended I move to that part of town."

For Dov's parents, Jonathan Shestack and Portia Iversen, Silicon Valley is the only place on Earth with enough critical mass of supercomputing resources, bio-informatics expertise, genomics savvy, pharmaceutical muscle, and VC dollars to boost autism research to the next phase. For six years, the organization they founded, Cure Autism Now, has led a focused assault on the iron-walled fortress of the medical establishment, including the creation of its own bank of DNA samples, available to any scientist in the field on a Web site called the Autism Genetic Resources Exchange (see "The Citizen Scientists," Wired 9.09, page 144).

At least a third of CAN's funding comes from donors in the Valley. Now Shestack and Iversen want to deliver the ultimate return on that investment: better treatments, smarter assistive technology - and, eventually, a cure.

"We have the human data," says Shestack. "Now we need the brute-force processing power. We need high-density SNP mapping and microarray analysis so we can design pharmaceutical interventions. We need Big Pharma to wake up to the fact that while 450,000 people in America may not be as large a market as for cholesterol drugs, we're talking about a demand for new products that will be needed from age 2 to age 70. We need new technology that measures modes of perception, and tools for neural retraining. And we need a Web site where families with a newly diagnosed kid can plug into a network of therapists in their town who have been rated by buyers - just like eBay."

The ultimate hack for a team of Valley programmers may turn out to be cracking the genetic code that makes them so good at what they do. Taking on that challenge will require extensive use of technology invented by two people who think in pictures: Bill Dreyer, who invented the first protein sequencer, and Carver Mead, the father of very large scale integrated circuits. As Dreyer explains, "I think in three-dimensional Technicolor." Neither Mead nor Dreyer is autistic, but there is a word for the way they think - dyslexic. Like autism, dyslexia seems to move down genetic pathways. Dreyer has three daughters who think in Technicolor.

One of the things that Dan Geschwind, director of the neurogenetics lab at UCLA, finds fascinating about dyslexia and autism is what they suggest about human intelligence: that certain kinds of excellence might require not just various modes of thinking, but different kinds of brains.

"Autism gets to fundamental issues of how we view talents and disabilities," he says. "The flip side of dyslexia is enhanced abilities in math and architecture. There may be an aspect of this going on with autism and assortative mating in places like Silicon Valley. In the parents, who carry a few of the genes, they're a good thing. In the kids, who carry too many, it's very bad."

Issues like this were at the crux of arguments that Bryna Siegel had with Bruno Bettelheim in a Stanford graduate seminar in the early '80s, published in Bettelheim's The Art of the Obvious. (Siegel's name was changed to Dan Berenson.) The text makes poignant reading, as two paradigms of scientific humanism clash in the night. Siegel told "Dr. B" that she wanted to do a large study of children with various developmental disorders to search for a shared biochemical defect. Bettelheim shot back that if such a marker were to be uncovered it would dehumanize autistic children, by making them essentially different from ourselves.

Still an iconoclast, Siegel questions whether a "cure" for autism could ever be found. "The genetics of autism may turn out to be no simpler to unravel than the genetics of personality. I think what we'll end up with is something more like, 'Mrs. Smith, here are the results of your amnio. There's a 1 in 10 chance that you'll have an autistic child, or the next Bill Gates. Would you like to have an abortion?'"


For UCSF neurologist Kirk Wilhelmsen - who describes himself and his son as being "somewhere on that grand spectrum" - such statements cut to the heart of the most difficult issue that autism raises for society. It may be that autistic people are essentially different from "normal" people, he says, and that it is precisely those differences that make them invaluable to the ongoing evolution of the human race.

"If we could eliminate the genes for things like autism, I think it would be disastrous," says Wilhelmsen. "The healthiest state for a gene pool is maximum diversity of things that might be good."

One of the first people to intuit the significance of this was Asperger himself - weaving his continuum like a protective blanket over the young patients in his clinic as the Nazis shipped so-called mental defectives to the camps. "It seems that for success in science and art," he wrote, "a dash of autism is essential."

For all we know, the first tools on earth might have been developed by a loner sitting at the back of the cave, chipping at thousands of rocks to find the one that made the sharpest spear, while the neurotypicals chattered away in the firelight. Perhaps certain arcane systems of logic, mathematics, music, and stories - particularly remote and fantastic ones - have been passed down from phenotype to phenotype, in parallel with the DNA that helped shape minds which would know exactly what to do with these strange and elegant creations.

Hanging on the wall of Bryna Siegel's clinic in San Francisco is a painting of a Victorian house at night, by Jessy Park, an autistic woman whose mother, Clara Claiborne Park, wrote one of the first accounts of raising a child with autism, The Siege. Now 40, Jessy still lives at home. In her recent book, Exiting Nirvana, Clara writes of having come to a profound sense of peace with all the ways that Jessy is.

Jessy sent Siegel a letter with her painting, in flowing handwriting and words that are - there is no other way to say it - marvelously autistic. "The lunar eclipse with 92% cover is below Cassiopeia. In the upper right-hand corner is Aurora Borealis. There are three sets of six-color pastel rainbow on the shingles, seven-color bright rainbow on the clapboards next to the drain pipe, six-color paler pastel rainbow around the circular window, six-color darker pastel rainbow on the rosette ..."

But the words aren't the thing. Jessy's painting is the thing. Our world, but not our world. A house under the night sky shining in all the colors of the spectrum.


Source: "Wired" Issue 9.12 - Dec 2001 - http://www.wired.com/

[A.J. Mahari]

WHAT IS ASPERGER'S?

Asperger's syndrome is a developmental disorder that is part of the autism spectrum. Signs and symptoms of Asperger's syndrome include:

• Engaging in one-sided, long-winded conversations, without noticing if the listener is listening or trying to change the subject
• Displaying unusual nonverbal communication, such as lack of eye contact, few facial expressions, or awkward body postures and gestures
• Showing an intense obsession with one or two specific, narrow subjects, such as baseball statistics, train schedules, weather or snakes
• Appearing not to understand, empathize with, or be sensitive to others' feelings
• Having a hard time "reading" other people or understanding humor
• Speaking in a voice that is monotonous, rigid or unusually fast
• Moving clumsily, with poor coordination
• Having an odd posture or a rigid gait

Source: MayoClinic.com