Asperger Syndrome and High-Functioning Autism: Psychiatric Implications

Defining Asperger Syndrome and High-Functioning Autism

Asperger Syndrome (AS) and high-functioning autism are oftentimes considered the same condition — or at least indistinguishable from each other — and the differences between the two are relatively minor. According to WebMD (Autism, 2015), the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, now lists Asperger's and autistic disorder as a single condition for diagnostic purposes, whereas previously they were listed separately. The new unified condition is known as autism spectrum disorder. Some experts believe the two should still be classified separately; Moran (2014) describes Asperger's disorder as a close relative of autism that can be distinguished by limited social interaction that does not coincide with a significant delay in acquiring language skills, as is normally found with autism. Moran further describes Asperger's as distinctive from autism in its restrictive and highly idiosyncratic patient interests.

One patient in the Moran study illustrates just how consuming the psychiatric and psychosocial influences on patients with AS can be. The patient was described as being so focused on a Japanese card game that it became totally absorbing, even to the "exclusion of all other age-appropriate attachments or interests" (p. 3). Such behavior can make Asperger's very difficult to treat. For example, the question arises of how to effectively and efficiently treat a group of patients if each happens to have different idiosyncratic or obsessive interests. The implication is that patients with AS may not be effectively treated in a group setting — though that does not necessarily hold true in every case.

Psychiatric and Psychosocial Challenges in Treatment

A recent study identified effective methods of treatment for Asperger's, including individual psychotherapy, social skills training, behavior modification, parent education, sensory integration, and educational interventions (Longhurst, Richards, Copenhaver, & Morrow, 2010). The same study, however, determined that group treatment of autism and Asperger's can be highly effective when modeled after the Positive Peer Culture (PPC) group meeting model, as long as accommodations are made to incorporate each student's unique strengths and limitations into the program. Therapists conduct formal group therapy sessions five days a week, modeled after the PPC group meeting format (Vorrath & Brendtro, 1985), with adjustments made to accommodate the students' individual profiles.

The implication, therefore, is that psychiatric treatment can be effective in helping young men and women who suffer from Asperger's Syndrome. As Longhurst et al. (2010) states, "these students spend each and every day trying to think, feel, and behave in ways that are totally foreign to their experience" (p. 40) — a difficult undertaking for anyone, let alone young children and youth navigating the general challenges of growing up. Oftentimes, these young people are so immersed in their own specific interests that their interactions with others are severely limited, and they find it difficult to share their feelings or thoughts with anyone.

Social Interaction Deficits and Anxiety

Fonseca (2009) described the problem in particularly apt terms, writing that bi-directional transactions within the dyadic space are necessary in order to acquire shared feelings, yet AS often results in severe impairment of these very processes. In that study, Fonseca found that some patients were so impaired that it led to the identification of a relationship style that only the patient could occupy — not the patient and another person. Although this was observed only within the dialogic space, such a lack of interaction, combined with obsessive-like behavior and narrowly focused interests, would significantly affect a young person's ability to assimilate into mainstream society. This could hold true even if other aspects of their social skills remained within normal range.

Fonseca also found that autistic symptoms can be understood as an expression of anxiety and a deficit of developed psychological structures, both of which increase the patient's inability to cope with separateness. Living a separate existence — even while surrounded by society — is a challenge for almost any human being. For individuals affected by Asperger's, the isolation that the disorder produces can be particularly difficult to manage.

Tebartz van Elst et al. (2013) found that traditional autism can often be defined as a severe neurodevelopmental disorder characterized by overtly abnormal language development, low IQ in the majority of cases, and significant learning difficulties. Some key differences between traditional autism and Asperger's or high-functioning autism include the fact that patients diagnosed as high-functioning often have normal to above-average intelligence, and are frequently not diagnosed until they reach adulthood. Many of the problems associated with traditional autism are absent in high-functioning patients; however, according to Tebartz van Elst et al. (2013), "high-functioning ASD is associated with a very high prevalence of comorbid classical psychiatric disorders such as depression, anxiety, ADHD, tics, psychotic symptoms or emotionally unstable syndromes" (p. 189).

Conclusion

With so many children and young people experiencing the effects of these disorders — and given that the disorders often persist into adulthood and sometimes throughout a patient's entire life — better diagnosis, assessments, and treatments would likely translate into a meaningfully improved quality of life for these patients.

References

Autism (2015). WebMD. Retrieved April 20, 2015, from http://www.emedicinehealth.com/autism/page8_em.html

Ban, E., Souverein, P., Meijer, W., Engeland, H., Swaab, H., Egberts, T., & Heerdink, E. (2014). Association between ADHD drug use and injuries among children and adolescents. European Child & Adolescent Psychiatry, 23(2), 95–102.

Beresford, T. P. (2014). Clinical assessment of psychological adaptive mechanisms in medical settings. Journal of Clinical Psychology, 70(5), 466–477.

Fonseca, V. R. (2009). The autistic dialogic style: A case of Asperger's syndrome. Journal of Child Psychotherapy, 35(3), 250–261.

Longhurst, J., Richards, D., Copenhaver, J., & Morrow, D. (2010). "Outside In" group treatment of youth with Asperger's. Reclaiming Children & Youth, 19(3), 40–44.

Macfarlane, A. H., Blampied, N. M., & Macfarlane, S. H. (2011). Blending the clinical and cultural: A framework for conducting formal psychological assessment in bicultural settings. New Zealand Journal of Psychology, 40(2), 5–15.

Moran, M. (2014). Asperger's may be answer to diagnostic mysteries. Clinical and Research News, American Psychiatric Association. Retrieved April 19, 2015, from http://pschnews.psychiatryonline.org/doi/full/10.1176/pn.41.19.0021

Pellow, J., Tech, M., & Solomon, E. M. (2011). Complementary and alternative medical therapies for children with attention deficit hyperactivity disorder (ADHD). Alternative Medicine Review, 16(4), 323–337.

Stanners, M. N., Barton, C. A., Shakib, S., & Winefield, H. R. (2014). Depression diagnosis and treatment amongst multimorbid patients: A thematic analysis. BMC Family Practice, 15(1), 2–12.

Tebartz van Elst, L., Pick, M., Biscaldi, M., Fangmeier, T., & Riedel, A. (2013). High-functioning autism spectrum disorder as a basic disorder in adult psychiatry and psychotherapy: Psychopathological presentation, clinical relevance and therapeutic concepts. European Archives of Psychiatry & Clinical Neuroscience, 263, 189–196.