Children with Asperger syndrome have difficulties interacting socially even though they have normal intelligence, as Hessel Willemsen explains
It is sometimes thought that the different types of autism might be on the increase. However, the apparent rise in cases may be related to a greater awareness of these disorders.
An autistic diagnosis may have become 'fashionable', and it may also be that parents, clinicians and even nursery nurses are eager to have a diagnosis - to be given 'an answer' - that will dispel their frustration.
Asperger syndrome is a type of autism. Children with Asperger syndrome usually have normal or even superior intelligence, but like those with classic autism, they have a great deal of social interaction problems and live in their own world. They do not usually have significant language delay, but can show some clumsiness and delay in motor milestones. And the absence of the symbolic function, which creates the possibility to imagine, to fantasise, to create and to think in abstract concepts, leads to many problems both early on and later in life.
Children with Asperger syndrome do not understand stories and fairy-tales that make use of imagination, and as a result they get distracted and bored. Neither can they play very well with their peers, because they cannot relate to the inner world of other children - although they do well in logical games and play, and are extremely sensitive to group rules.
Lack of empathy
Children with this condition cannot empathise with other children. When another child is upset the child with Asperger syndrome might start laughing, be surprised or not react at all. Their behaviour is often complicated by severe tantrums, which result from the level of frustration these children experience.
Their aggression may be very high and sometimes leads to uncontrollable rage, which may then be followed by a period of isolation. Older children often can tell someone and acknowledge there is something 'wrong', but they cannot point out or explain what it is that is bothering them. There are some cases where toddlers head-bang and rock.
Such a child can hardly share anything with other children, and asks for continuous attention from one person. In fact, they live with a deep ingrained fear of relating to others. As a result of a lack of imagination the inner world of this child is very empty. There is some, rather unconscious, recognition of this which results in envy towards those who do have affectionate relationships with others. The child experiences a highly frustrating conflict between strong longings to relate and the fear of doing so, which they often act out when they feel left out by other children or by an adult who gives attention to another child.
These children tend to get overlooked in their young years. Although they are not playing with other children, they may not get rejected either. They are often observed as isolated, frustrated children when observed by professionals.
This is different from the adult reaction to children with classic autism, which, as a result of speech and language delay, is often identified earlier. Children with classic autism also display higher levels of anxiety, which leads parents to seek help earlier, while a child with Asperger syndrome displays high levels of anger and envy.
The characteristics of classic autism and Asperger syndrome overlap, and confusion remains among clinicians over the diagnostic criteria for both. But in short, children with classic autism usually exhibit language delay, cognitive delay and clumsiness, while children with Asperger syndrome may not present these behaviours at all. Autistic children usually have retarded mental functioning, while children with Asperger syndrome usually have normal, if not superior, intelligence.
It is best to advise parents to seek specialist help if a child shows behaviour that might lead to a diagnosis of classic autism or Asperger syndrome. Many children with Asperger syndrome have been wrongly diagnosed with classic autism, pervasive developmental disorder, post-traumatic stress disorder, dyslexia, dyspraxia or other diagnoses.
In quite a few cases children have been diagnosed with Asperger syndrome around the age of nine or later. Until this age, the child has been able to get on well at school and usually achieves good grades. But generally, around the age of nine and ten, children develop the ability to think on an abstract level, which makes it possible to do more complicated mathematics, for example. This is when the school results of a child with Asperger syndrome start to deteriorate and, after interventions at school have been made without success, the child gets referred to mental health services.
Although it was previously thought that children with autism and Asperger syndrome could not be treated, research is now available providing insight into this complicated behaviour. The evidence suggests that some children are responding to long-term psychotherapeutic interventions and family therapy effectively, helping them to create and develop their symbolic function. Although some people with the syndrome have severely disabled lives, others achieve quite normal social positions and family lives.
Underlying causes
If children are seen by a mental health professional, the rest of the family is usually interviewed as well. Living with a child with Asperger syndrome has often been a source of trauma in the family. One of the main questions families tend to ask is about the nature of the diagnosis. Researchers still disagree - some argue that the cause is biological (nature), while others think psychological and environmental factors (nurture) are the main precipitators. Some also think that perhaps a combination of these two, where a sensitive child lives in unfavourable developmental circumstances, might be causing this complex and frustrating behaviour. NW
Hessel Willemsen is a child and adult clinical psychologist who is employed by the Tavistock Clinic for psychotherapy and child mental health in London
Understanding your own feelings
Children with Asperger syndrome evoke strong feelings of frustration in people working with them. This is often followed by strong feelings of guilt because the needs of the child cannot be attended to or met. Adults need to understand and expect that when a such a child is introduced to pretend-play and imagination, he will find it very difficult, if not impossible, to engage in. In a peculiar way the child feels safe in his own world and frightened of relating to people in another way.
Like the child, the adult will feel continuously frustrated, because neither of them can find a bridge to cross. These children may evoke feelings of despair, leading to anger and rage in the worker which do not often disappear after 5pm.
Like the child and like the parents, the worker will at times feel disempowered, and then feel guilty about their sense of anger towards this child. Depression when working with these children is not uncommon for both parents and professionals.
