On September 22 in New York, a sixteen-year-old schoolgirl from Sweden Greta Thunberg gave an emotional speech at the UN climate summit. The girl criticized world leaders and accused them of ignoring environmental problems. According to Greta, she began to be interested in environmental issues at the age of eight, but took decisive action last year. She began organizing single pickets outside the Swedish parliament on Fridays. After some time, her idea was supported by tens of thousands of schoolchildren around the world.
Who is Greta Thunberg? More details
Four years ago, doctors diagnosed Greta with Asperger's syndrome. This disease is often compared to autism, but it goes away easier: patients retain the ability to express thoughts coherently, but at the same time experience difficulties with communication and become fixated on one activity.
What is Asperger's syndrome?
Asperger syndrome (lat. Asperger syndrome) is an autism spectrum disorder.
Autism syndrome differs from ordinary autism in that the patient’s cognitive and even speech abilities are generally preserved.
“Related” diseases of the syndrome are:
- atypical autism;
- psychosis;
- high functioning autism;
- Rett syndrome and some others.
Patients are characterized by difficulties in communication, stereotypical behavior and limited interests. These disorders are of a deep nature, interfering with normal life activities.
It is noteworthy that the disease is congenital, which means it cannot appear as a result of the child’s development in the first years of life. However, upbringing and environment significantly influence the course of Asperger's syndrome.
There are different opinions about how often Asperger syndrome manifests itself in childhood. Statistics indicate 0.36 - 0.71 percent of cases, but experts give a completely different figure: in their opinion, children have symptoms in 30 or even 50 percent of cases.
Discovered only in the first half of the twentieth century, Asperger syndrome did not attract the attention of scientific and medical circles for a long time. “Strange” children were given various diagnoses, from atypical autism to childhood schizophrenia, and adults were considered simply ill-mannered people, chronic losers, unprincipled boors. The real reason for the strange behavior was revealed later.
When can Asperger's syndrome be diagnosed and how does it manifest?
Asperger's syndrome manifests itself from an early age. Thus, some children early discover the ability to understand themselves and those around them in a non-standard way. At the same time, as observations show, people with Asperger syndrome experience difficulties in conveying their own emotions to their interlocutor. It is difficult for them to interpret signs, such as intonation, facial expressions, and gestures, which do not cause any difficulties in perception by other people. It is difficult for them to read the tone of voice, facial expression of the interlocutor, perceive hints, etc. Sometimes they find it difficult to express themselves emotionally. When using complex words and phrases, they may not fully understand what they mean. They have difficulty understanding jokes, anecdotes, metaphors and sarcasm.
People with this disorder do not understand established social norms, for example, they may stand too close to another person, start conversations about inappropriate topics, or behave inappropriately. In addition, they can give the impression of indifference and indifference to other people.
Having a reduced ability to empathize, people with Asperger's syndrome show their emotions in a way that is not always understandable to others. Unlike people with autism, they have less severe speech problems. The intelligence of such patients is often normal (overall IQ is at least 70, with verbal intelligence better developed and non-verbal intelligence worse) or above normal.
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Causes of Asperger's Syndrome
Asperger's syndrome has been studied since 1944, but during this time the causes of the syndrome have not been fully identified. Since the disease is congenital, opinions have been expressed about its genetic origin.
Researchers about the syndrome, relatives may also have signs characteristic of the disease, most often in a milder form - for example, some disturbances in communication. This was also pointed out by Hans Asperger himself, who studied not only his young patients, but also their families.
It has also been noted that autism spectrum disorders have a similar genetic nature.
Modern research has shown that the direct mechanism of the disease is a disruption of neural connections in the brain - because of this, the control of a person’s mental life differs from normal.
Causes
The study of the causes of Asperger's syndrome continues to this day and is quite far from completion. The origin and development of the disease has not yet been identified.
The main theory put forward is the idea of an autoimmune reaction of the mother's body, which in turn causes brain damage in the fetus. To date, the hypothesis of hormonal imbalance in a child (changes in cortisol and testosterone levels) has not yet found reliable confirmation. In addition, the connection between autistic disorders and pathologies such as prematurity, attention deficit hyperactivity disorder, etc. is being studied.
No less likely risk factors for the occurrence of Asperger's syndrome are considered to be hereditary predisposition, being male, intrauterine viral infections (herpes, rubella, measles, toxoplasmosis, cytomegalovirus, etc.), and exposure of the fetus to toxic substances in early pregnancy.
Symptoms of Asperger's Syndrome
There are many manifestations of Asperger's syndrome; Every life situation reveals its own “oddities.”
However, there are common symptoms that indicate the presence of this disease. Their appearance can be noted starting from 3 years of age. Until this moment, the child develops normally - in due time he learns to sit, walk, and talk.
Difficulties begin at higher stages of mental development:
- The child does not want to make contact with people around him. He does not communicate (or communicates poorly) with family members, with friends in kindergarten or at school. He does not take the initiative to make acquaintance or contact. If contact has taken place, then the patient with Asperger’s has difficulty understanding the emotions of the interlocutor, does not recognize shades of intonation, gestures and facial expressions; does not understand a joke - he takes speech addressed to him literally.
- The patient's speech often does not contain emotions, words are pronounced monotonously. The child cannot find the right words to explain what he needs. Because of this, the child is considered stupid, at school they give a low grade due to the fact that he allegedly did not learn the lesson; in fact, the situation is the opposite - he can very quickly learn a topic (literally by heart), but communication disorders prevent him from reproducing what is necessary.
- If a carrier of Asperger's syndrome begins to speak confidently, then, as a rule, he gets carried away with a long monologue. He does not understand how his interlocutors react to his speech, whether they are interested in it or not. The child often does not look the interlocutor in the eyes, he does not pause in his speech, which is necessary for the listeners to perceive his words. His monologue resembles a playback of a sound recording. The strange thing here is that the speaker is fully aware that he is communicating with another person.
- The speech of “Aspergers” looks even more strange due to the almost complete absence of facial expressions and gestures. Even his gaze during a conversation is directed into emptiness. This unnatural pose is noted even in photographs.
- Another fundamental symptom is the desire for order. The child tries to arrange things in an “ideal” way: arranges toys by color, shape, size, puts objects in strictly defined places. If he left a thing in one place, and then someone moved it to another, but very close, then upon his return the child may not find it at all. This often occurs in adults with Asperger's syndrome.
Fairy Tricks and Rain Man
"Going Crazy: A City Resident's Guide to Mental Disorders"
In medieval Britain, parents had to carefully look after a child, especially a pretty one - he could be kidnapped by fairies at any moment. After all, as you know, magical creatures love human children and gladly raise them in their kingdom. And in their place they put their own offspring, bewitching the changelings so that they look very similar to the missing ones. But it was possible to distinguish an elven child by a number of signs - these included the baby’s unsociability and uneven development, as well as an unexpected love and ability for one type of activity (usually music). Among some scientists and writers who have studied the history of autism, there is an opinion that children with various developmental disorders - including regressive autism (when a child develops normally until one or two years of age, and then begins to show symptoms of the disorder) were mistaken for changelings.
With the strengthening of Christianity, belief in fairies gradually turned into belief in satanic tricks. One of the supposed cases of autism was mentioned in Martin Luther's table talk tapes - it talked about a 12-year-old boy who allegedly suffered from this developmental disorder. Luther's verdict was merciless: he advised strangling the child (according to another version, drowning him), considering him a creature of the devil - a body without a soul. “He (the devil) is capable of harming children, causing heart disease, blindness, stealing them, or even removing children from the cradle and laying himself in the place of the stolen child,” Luther wrote. In 1747, the marriage of Scottish nobleman Hugh Blair to the daughter of a local doctor was annulled due to the groom's strange behavior. According to the memoirs of contemporaries, Blair had little understanding of decency and the nuances of communication (for example, he could come to visit without asking), always wore the same clothes (he put patches on leaky places, cutting them out of new clothes - often borrowed from others), collected bird feathers and always showed up for any funeral in the city, regardless of whether he knew the deceased. However, the dissolution of the marriage did not occur without the participation of John, Hugh’s younger brother, who was not interested in the emergence of new heirs to the estate and title. As science developed, it became clear that strange behavior was not caused by fairies and demons, but by an imbalance in mental and neurological processes. The term “autism” (from the Greek “self”) was coined by Swiss psychiatrist Eugene Bleuler in 1910. True, then he used it primarily to designate a symptom of schizophrenia. And in 1944, Austrian psychiatrist and psychotherapist Hans Asperger described four children with limited empathy, physical awkwardness, narrow interests and poor nonverbal communication abilities. A year earlier, his compatriot Leo Kanner, who immigrated to the United States, described the same disorder. There was a war going on, so for a long time Asperger's work went unnoticed in the United States. Only in 1991 were his works translated into English and made available to a wide range of specialists.
The first half of the 1940s was not a good time for people with mental disorders and developmental disabilities. The details of Asperger's relationship with the Nazis are unknown, but according to the popular view, the Third Reich, interested in eugenics projects and getting rid of all the "extras," supported the psychiatrist's research. But Asperger deliberately exaggerated the positive aspects of his patients and proved their necessity for society in order to save them from extermination. The doctor called his charges “little professors” and predicted that their unusual abilities would be used in the future. Towards the end of the Second World War, he opened a school for children with “autistic psychopathy” - but it was bombed and much of the psychiatrist’s work was lost.
People with Asperger's syndrome are characterized by narrow interests, problems with communication and other characteristics of perception and behavior, but their speech and cognitive abilities are developed so much that they allow them to more or less adapt in society, and in some cases, to succeed. By the way, the image of the hero of the film “Rain Man” Raymond Babbitt, whom the average viewer perceived as one hundred percent autistic, was in fact based on a person with a completely different diagnosis. His prototype, American Kim Peek, was born with a cranial hernia and damage to the cerebellum. The structural features of the brain formed a phenomenal memory - Peak remembered up to 98% of incoming information. This is a vivid example of savantism - the incredible talent of a person with developmental disabilities. About 50% of savants are autistic, but only 10% of autistics become savants.
Diagnostics
Identifying Asperger's syndrome is actually not an easy task. To do this, specialists from different fields are involved - psychologists, psychiatrists, neurologists, geneticists. Various studies are needed because the manifestations of the syndrome are similar to the symptoms of other disorders.
Diagnostics of children
It is important to detect symptoms in children as early as possible because this makes treatment easier. To make a diagnosis, conversations are held with the child, including tests and games.
In addition, the specialist talks with the child’s parents to obtain information about his behavior in the family, at school, and during everyday activities. A conversation with parents will help identify manifestations of the syndrome in them.
Diagnosis of adults
Asperger syndrome is more difficult to identify in adults because symptoms of the disease change with age. However, there are a number of methods to diagnose the disorder in adults. These include, in particular, standard tests:
- 1.Test. Based on an analysis of the patient's perspective. The test is often carried out using a photo. As already mentioned, the gaze of a person suffering from the syndrome expresses nothing and is directed to nowhere.
- 2.Test. Determines the degree of empathy - the emotional development of the subject. Aspergers have lower scores on this test than healthy people.
- 3.Test. Shows the presence of ritual behavior, “obsession”.
Aspies love order and make their own rules
The world sometimes seems so confusing and disorderly that people with Asperger's syndrome try to “bring order.” So, they often make their own rules. For example, a man gets to work by only one route.
Aspergers also often create their daily routine according to a pattern and strictly follow it. For example, a working day in an office begins and ends at a certain time. And if you are late for work for a second or stay late, excitement and anxiety will immediately come flooding back.
Treatment for Asperger's Syndrome
Since Asperger syndrome is a genetic disease of the “psychological” sphere, there are no methods of drug treatment for it.
However, there are drugs that can treat concomitant diseases - nervousness, depression, sleep disorders, inattention, and a tendency to self-harm. Some medications can even eliminate repetitive actions and behavioral patterns.
The main methods of treating Asperger syndrome are cognitive behavioral therapy, occupational therapy, and social and communication skills training. Physical therapy is also used, which helps to correct coordination of movements and improve sensory skills.
Children are offered classes with a speech therapist; Its task is to develop the child’s skills in conveying emotions, to teach him to make speech bright and expressive. In addition, visits to a psychologist and a special education teacher are necessary, who will teach the child to navigate the world around him.
Ideally, therapy for the syndrome should be mixed: psychological, behavioral and cognitive methods should be combined with the use of supportive medications aimed at improving the patient’s well-being.
Treating Asperger's syndrome in adults, as well as diagnosing the disease, is much more difficult than in children. In particular, because adult carriers of the disease have already become established individuals, they are critical of treatment attempts and often do not consider their condition to be a disease.
Diagnostic features
Some manifestations of the syndrome can be determined by parents or teachers, doctors (pediatricians, psychiatrists, speech therapists, neurologists, speech therapists).
For diagnostics the following are used:
- anamnesis analysis;
- survey of children;
- observation;
- testing.
To make a differential diagnosis, in some cases an electroencephalogram and MRI are required. These examinations will show whether there is a risk of complications and exacerbations of pathology.
The complexities of the social imagination
Individuals with Asperger's syndrome are famous for their very rich imaginations. Many become famous artists, writers or musicians.
However, people with Asperger's syndrome have great difficulties in social imagination, namely: the inability to predict possible options, non-acceptance of the opinions of others, the inability to interpret the feelings, thoughts or actions of another person. In addition, patients with Asperger's syndrome have limitations in their creative activity, since only repetitive, sequential activity is acceptable for them.
Social interaction or cooperation
People with Asperger's syndrome find it very difficult to form and maintain friendships. They do not understand that friendship requires such concepts as the ability to wait, empathize and sympathize, support each other, and discuss not only topics that interest them, but also those that are interesting to the intended friend.
Incorrectness and often tactlessness in communicating with others pushes people away from them. Over time, patients with Asperger syndrome can learn norms of behavior and concepts of friendship, which is rather based not on understanding all of the above, but on intuitive copying (such patients have a very subtle mental organization) of other people.
Often, patients with Asperger's syndrome offend others with their statements, without meaning to or understanding it themselves.
Symptoms
People with Asperger's syndrome have particular problems in the following social areas: communication, interaction and imagination.
Classic symptoms of Asperger's syndrome:
- difficulties with nonverbal communication;
- problems with the perception of the world;
- deficit of emotions, creative imagination and thinking.
These signs are called the “triad of core symptoms” of high-functioning autism and may not appear all at once and may not be as obvious. Relatives should be wary if there is a person in their environment who is susceptible to:
- increased suspicion;
- physical clumsiness;
- frequent depression;
- getting used to a certain place of residence;
- outbursts of rage, irritability;
- misunderstanding of figurative speech, jokes;
- difficulties in friendly communication and interaction;
- behavior patterns.
The last point includes getting used to a certain type of hobby, the order in which things are arranged in the home, and performing repetitive actions. If order is disturbed, it causes a storm of negative emotions, serious nervous shock, and hysteria. The disease is diagnosed in childhood, but in some cases it can be asymptomatic until a certain point.
How to distinguish childhood autism from Asperger's syndrome?
The differences between Asperger's syndrome and childhood autism are presented in the table:
| Criterion | Asperger's syndrome | Childhood autism |
| Characteristics of the condition | Psychopathic process | Psychopathy |
| Forecast regarding further socialization | Adverse | Relatively favorable |
| Self-awareness | The child is closed in his own world | The child lives in society, but according to his own rules |
| Eye contact | Doesn't notice other people, although he can look them in the eyes | Avoids making eye contact with other people |
| Communicative function of speech | The child communicates using speech, although mostly unilaterally | Speech is not a means of communication |
| Motor and speech development | Speech development is ahead of the ability to walk. | Speech development is delayed or absent altogether. The child will begin to walk earlier than he can talk. |
| Manifestation of violations | After 3 years | Infancy |
Forecast
Some evidence suggests that children with Asperger's syndrome experience less symptoms with age; up to 20% of children no longer meet the criteria for the syndrome as adults, although social and communication difficulties may persist. As of 2006, there were no long-term outcome studies of Asperger syndrome or systematic long-term studies of children with the syndrome. Individuals with Asperger's syndrome appear to have a life expectancy similar to the general population, but have an increased incidence of comorbid psychiatric disorders such as clinical depression and anxiety disorder, which can significantly complicate prognosis; there is a possibility of suicidal behavior. Although social impairments persist throughout life, the prognosis is generally better than that of autism spectrum disorders, which lead to more severe impairments in functioning; for example, autism spectrum symptoms are more likely to improve over time in children with Asperger's syndrome and high-functioning autism. Although most students with Asperger's syndrome have average math ability and score somewhat lower on math tests than on general intelligence tests, some are gifted in mathematics, and Asperger's syndrome has not prevented some adults from achieving significant achievements, even winning a Nobel Prize.
Although many attend regular classrooms, some children with Asperger syndrome are eligible for special education because of their social or behavioral problems. Teens with Asperger syndrome may have ongoing difficulties with self-care or organization, and may be agitated and anxious about problems in social and romantic relationships. Despite their high cognitive potential, most young adults with Asperger's syndrome remain at home, although some manage to get married and work independently. Being different from others can be traumatic for teenagers. Causes of anxiety may include preoccupation with possible disruptions to routines and rituals, being placed in a situation without clear schedules or expectations, or due to worry about failure in social interactions; Stress as a result of anxiety can manifest itself as inattention, withdrawal, obsessiveness, hyperactivity, aggressive or oppositional behavior. Depression often results from chronic frustration due to persistent failure to get other people interested in you, and mood disorders that require treatment may occur. Clinical experience suggests that suicide rates are increased in individuals with Asperger's syndrome, but this has not been confirmed by systematic empirical research[.
Educating families is critical to developing strategies for understanding strengths and weaknesses; family assistance improves the prognosis for children. Prognosis may be improved by diagnosis at an early age, allowing early intervention, whereas intervention in adulthood is less useful, although still valuable. Individuals with Asperger's syndrome are at risk of exploitation by others and may be unable to understand the social consequences of their actions.
