About the Spectrum

What is Asperger Syndrome, Autism, PDD-NOS

What is Asperger Syndrome?
Asperger Syndrome (AS) is generally considered to be a form of autism. Unlike the more severe forms of autism, people with AS exhibit little or no impairments in their speech (at most a mild delay in early childhood). But like many people with autism, they have a level of intelligence at least in the average range and often in the above-average or even superior ranges. And as with all other forms of autism it is characterized by varying degrees of deficits in social interactions and non-verbal communications. More specifically, people with AS have difficulties, sometimes severe, in perceiving the world from the perspective of another person and in “picking up” on the social “cues” (facial expressions, bodily gestures, tone of voice, etc.) that constitute such a significant part of many human interactions. As a result, having AS can mean having great abilities or talents in certain areas, but can also mean never living independently, never holding down a job for any extended period of time, and perhaps never even enjoying an intimate relationship. At the very least, it often means being an outcast and even subject to victimization in school, in the workplace, and in personal life.

Although there is no single distinguishing trait or characteristic common to all people with AS, and very few that are exclusive to this condition, there are numerous behaviors and traits that are commonly observed in individuals who have AS. These include:

• very intense interests in highly specialized and often unusual areas (which can range from train routes and schedules to sports statistics to geographic or national facts to astronomy or even astrophysics) that preclude attention to or conversation about other subjects;
• inflexible routines in personal habits (insistence on always doing things the same way) towards which there is great resistance to change;
• repetitive bodily motions (such as flapping of the hands or feet and rocking back and forth);
• awkward physical coordination (“clumsiness” and difficulty with sports);
• unconventional body language, inappropriate facial expressions, and poor eye contact (which often causes others to misinterpret their intentions);
• unusual speech patterns (such as a noticeably peculiar tone or modulation of voice);
• atypical conversation (such as inappropriate remarks or irrelevant statements, and a formal “professorial” style of speaking that is more a lecture than a reciprocal conversation with another person);
• strong tendencies to be very literal in understanding of spoken or written language (which can make them very susceptible to being fooled or tricked);
• lack of awareness of their social environment or of the feelings of others (which can make them appear unemotional, unempathetic, or insensitive);
• remarkable memory for facts or details; exceptional abilities with numbers or patterns In addition, a few more specific behaviors and traits often observed in younger children with AS include: • slight delay in the use of speech (particularly complete sentences);
• reversal of pronouns (such as “you” instead of “I”, and vice-versa);
• incessant repetition of favorite topics, expression, or words;
• lining-up toys or other objects in a row;
• very strong attachment to specific objects or items;
• intense fascination with spinning objects; possibly exceptional ability to make things spin (e.g., a top) As in other forms of autism, people who have AS sometimes have very acute sensory sensitivities. In particular, they can react strongly to sounds or visual stimuli that are not even perceptible to most people (such as the high-frequency sound emitted from the back of a television or the “flickering” of a fluorescent light).

Similar issues concerning the fragrances of perfumes and toiletries, the tastes of foods, and the textures of clothing are also not uncommon. Asperger Syndrome was first described in 1944 by the Austrian pediatrician Dr. Hans Asperger. During the period following the Second World War, his work did not receive any attention in the rest of the world and was essentially forgotten until the late 1980’s when it was finally re-discovered in Great Britain. It was not recognized in the United States until 1994, when it was incorporated into the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) of the APA (American Psychiatric Association). Since that time, it has been recognized that the number of individuals with autism spectrum conditions, including AS, is much greater than was previously believed.

In the United States, the DSM-IV diagnostic criteria for Asperger Syndrome (299.80) are generally used as the definition of this condition.

The above descriptions of common traits, however, were not given as formal diagnostic criteria, but were written to be more useful for the lay person in recognizing the characteristics of AS in a neighbor, coworker, friend, relative, immediate family member, parent, child, or perhaps even himself or herself.

—Karl Wittig

What Is Autism?
Autism is considered to be the most severe of the autistic spectrum conditions. It is also known as Classic Autism, Early Childhood Autism, and Kanner’s Syndrome. People with Autism have speech problems ranging from speech delay to being completely non-verbal. They may have normal intelligence or be profoundly or moderately challenged mentally. They have a higher than normal incidence of seizure disorders. Intelligent people with Autism are said to be “high-functioning,” and may be difficult to distinguish from people with Asperger Syndrome (in the future, these two groups may share the same classification). Autism covers an extremely broad range of levels of functioning, of abilities and disabilities. They share with all other autistic people the impaired ability to perceive social cues and to place themselves in the minds of others.

In practical terms, this means that people with Autism rarely achieve complete independence as adults. They may never hold a job or have an intimate relationship. Like all autistic spectrum conditions, Autism is present very early in life and people do not outgrow it. However, with the right supports, there is always the ability to improve drastically. People with Autism have many typical behaviors. While all people with Autism do not share all of these traits, these are some traits that are commonly observed:

• Intense preoccupation with restricted and stereotyped patterns of interest. Examples include a preoccupation with numbers or with colors, or parts of particular objects.
• Inflexible and non-functional routines and rituals. This means that things are done in the exact same way each and every time, and there is great distress if this pattern is broken.
• Stereotyped body motions including hand flapping, body rocking, grimacing, finger flicking, peculiar gait, odd posture and complex whole body movements.
• Acting as if other people do not exist. This includes no eye contact or recognition that another person is present. Or, the other person may be treated as an object.
• No verbal communication or highly unusual communication. This can include an odd tone of voice (prosody), perseveration, inability to start and maintain a conversation, and idiosyncratic speech.
• Restricted emotional expressiveness including a flat and faraway gaze.

People with Autism have extremely acute senses. They may be very sensitive to the gentlest touch, the slightest noise, and the mildest scent. They may recoil from the texture of food. And they may be unaware of pain, hunger, and not react to loud noises at all.

Autism was first described by the Austrian-American pediatrician Leo Kanner in 1943. Dr. Kanner called it Early Childhood Autism. Unlike Asperger Syndrome, which only came to the public’s attention in the 1990s, Autism has been recognized but poorly understood since Dr. Kanner’s discovery. It is included in the DSM-IV (Diagnostic and Statistical Manual of the American Psychiatric Association) as Autistic Disorder.

—Allen Markman

What Is PDD-NOS?
PDD-NOS stands for Pervasive Developmental Disorder Not Otherwise Specified. PDD-NOS is a diagnosis listed in the DSM-IV (Diagnostic and Statistical Manual of the American Psychiatric Association). PDD-NOS is a diagnosis given when an individual on the autistic spectrum does not qualify for a formal diagnosis of these other conditions. They may not meet the threshold of severity for one of these conditions, or they may not fulfill enough of the formal criteria. They may have some of the behavioral traits of Autism or Asperger Syndrome, but may not meet the minimum requirements for a diagnosis. Sometimes young children may receive a diagnosis of PDD-NOS when the examiner is not sure that they have Autism. As they grow and mature it becomes easier to make a diagnosis and they may lose the PDD-NOS label and get a diagnosis of AS or Autism later on. Adults can have a diagnosis of PDD-NOS when their autistic condition is “atypical.” This means that the presentation of the condition may be unusual and not typical.

PDD-NOS is not so much a specific condition as a statement that the individual with this label is somewhere on the autism spectrum, but we don’t have a better name for it yet.

—Allen Markman

If you would like to know more about diagnoses that sometimes accompany autism spectrum conditions, such as Williams Syndrome, OCD, Landau-Kleffner Syndrome, ADD, Fragile X Syndrome…etc, go to Autism Network International’s wonderful “Specific Disabilities and Syndromes” page.