Childhood Disorders 637
Josh is not aware when he is too loud, because he isn’t able to read other peo-ple’s nonverbal signals appropriately. Such social communication problems can lead
to depression and anxiety in people with Asperger’s: They are unable to understand
and respond to others appropriately and thus may be rejected or ridiculed (Meyer
et al., 2006). Their problems in understanding social cues can also lead to diffi culty
in feeling empathy (Lawson, Baron-Cohen, & Wheelwright, 2004).
People with Asperger’s often fall into one of two social patterns: (1) They be-come socially isolated, minimizing contact with others (they are similar to people
with autism in this regard); or (2) they become socially annoying, seeking out interac-
tions with others but, because of their limited social skills, imposing their desires on
others. Children with Asperger’s often do best socially when interacting either with
adults (who are more tolerant of their social foibles) or with younger children, who
are willing to be bossed around by an older child (Kundert & Trimarchi, 2006).
Distinguishing Between Asperger’s Disorder
and Other Disorders
Asperger’s disorder can sometimes be diffi cult to distinguish from other disorders,
particularly autism without comorbid mental retardation. However, two factors
typically arise in autism but not in Asperger’s disorder:
- language problems in addition to social diffi culties, and
- extreme distress when change is foisted upon them.
Even in the area of social functioning there can be differences: An individual
with autism is often uninterested in social interactions, whereas an individual with
Asperger’s may be interested but does not possess the social skills necessary for
smooth interactions.
Some symptoms of Asperger’s disorder overlap with those of schizoid person-ality disorder (Chapter 13): Both disorders involve a lack of close friendships and
a preference for solitary activities. However, older children and adolescents with
Asperger’s are more interested in social interactions and relationships than are peo-
ple with schizoid personality disorder.
People with Asperger’s are distinguished from those with normal social awkward-ness by their diffi culty in understanding social cues. Furthermore, the all-consuming
CASE 14.3 • FROM THE OUTSIDE: Asperger’s Disorder
Josh is described by his older brother Ryan, a college student.
Josh, a lot of the times is to himself [sic]. He’s off to the side, he likes to be in his own little
world. And he’s got kind of... I want to say, a downward pull, he wants to think that everyone
wants to threaten him. For the longest time I’d yell at him because I’d say, “Stop crying, why
are you crying? There’s no need to cry. I didn’t say anything!” But to him, it’s a threat if you say
something and... he can’t control the way he feels....... when he needs his time, you give him his time. And when he’s ready to come out and be
social again, then he’ll come out.
And I try my best to introduce him to all the people that I know so he doesn’t feel uncom-
fortable and alone.
... when he’s doing something that he wants to learn about or that he’s interested in or that
I’ve done, he’s extraordinarily lively. He’s very happy. And that’s when he gets to his loud stages
where he’ll laugh and he’s way up there. I love to see him laugh, but when something is funny
he is, horrendously loud, he’s over the top... sometimes I’ll take his hand and I’ll give him a
little squeeze on the hand and that’s kind of his cue to kind of like ease it down a little bit.
Josh is amazing at directions... he can give directions to anybody to anything, if you are
anywhere in the US, he’ll tell you where you are.... I get lost all the time, directions are not
my thing and... I’ll call Josh, now... when like, I’m out on the road.... I’m like “Josh, I don’t
know where I’m at” and he’ll say like, “ What’s around you?” and I’ll tell him and he’ll know
exactly where I am. It’s really cool.
(Coulter, 2007)
Table 14.7 • Asperger’s Disorder
Facts at a GlancePrevalence- The estimated prevalence for Asperger’s
disorder is around 0.25–0.8% (Fombonne,
2005; Ozonoff, Rogers, & Hendren, 2003),
depending on the exact criteria used, the
research methods used, and the popula-
tion studied.
Onset- Although symptoms may emerge during
early childhood, Asperger’s is often not
diagnosed until the child is in elemen-
tary or middle school because academic
performance is normal. In some cases,
the child’s diffi culty in social situations
is not understood as a defi cit but viewed
as willful behavior.
Comorbidity- Depression and anxiety disorders are
the most common comorbid disorders.
Attention-defi cit/hyperactivity disorder
may also co-occur. - Asperger’s is the only pervasive develop-
mental disorder that cannot be comorbid
with mental retardation—the DSM-IV-
TR criteria stipulate normal cognitive
development.
Course- As children with Asperger’s disorder
enter adolescence and adulthood they
may become aware of their social dif-
fi culties and isolation; this awareness
may contribute to comorbid depression.
However, many children with Asperger’s
are able to improve their social skills. - Asperger’s disorder has a good progno-
sis, and the higher the individual’s IQ,
the better the prognosis. Most people
with Asperger’s are able to work and be
self-suffi cient.
Gender Differences- At least fi ve times more males than
females are diagnosed with Asperger’s
disorder.
Source: Unless otherwise noted, the source for
information is American Psychiatric Association, 2000.