Asperger syndrome

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

Asperger syndrome
Classifications and external resources

ICD- 10	F84.5
ICD- 9	299.8
OMIM	608638
DiseasesDB	31268
MedlinePlus	001549
eMedicine	ped/147

Asperger syndrome — also referred to as Asperger's syndrome, Asperger's, or just AS — is one of five neurobiological pervasive developmental disorders (PDD) that is characterized by deficiencies in social and communication skills. It is considered to be part of the autistic spectrum and is differentiated from other PDDs and from high functioning autism (HFA) in that early development is normal and there is no language delay. It is possible for people with AS to have learning disabilities concurrently with Asperger syndrome. In these cases, differential diagnosis is essential to identify subsequent support requirements. Conversely, IQ tests may show normal or superior intelligence, and standard language development compared with classical autism. The diagnosis of AS is complicated by the lack of adoption of a standardized diagnostic screen, and, instead, the use of several different screening instruments and sets of diagnostic criteria. The exact cause of AS is unknown and the prevalence is not firmly established, due partly to the use of differing sets of diagnostic criteria.

Asperger syndrome was named in honour of Hans Asperger (1906-1980), an Austrian psychiatrist and pediatrician, by researcher Lorna Wing, who first used the eponym in a 1981 paper. In 1994, AS was recognized in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Asperger's Disorder.

AS is often not identified in early childhood, and many individuals do not receive diagnosis until after puberty or when they are adults. Assistance for core symptoms of AS consists of therapies that apply behaviour management strategies and address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Many individuals with AS can adopt strategies for coping and do lead fulfilling lives - being gainfully employed, getting married or having successful relationships, and having families. In most cases, they are aware of their differences and recognize when they need support to maintain an independent life. There are instances where adults do not realize that they have AS personalities until they are having difficulties with relationships and/or attending relationship counseling. Recognition of the very literal and logical thought processes that are symptomatic of AS can be a tremendous help to both partners in a close/family relationship.

Classification and diagnosis

AS correlates with Asperger's Disorder defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by six main criteria. These criteria define AS as a condition in which there is:

1. Qualitative impairment in social interaction;
2. The presence of restricted, repetitive and stereotyped behaviors and interests;
3. Significant impairment in important areas of functioning;
4. No significant delay in language;
5. No significant delay in cognitive development, self-help skills, or adaptive behaviors (other than social interaction); and,
6. The symptoms must not be better accounted for by another specific pervasive developmental disorder or schizophrenia.

AS is an autism spectrum disorder (ASD), one of five neurological conditions characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behaviour. The four related disorders or conditions are Autism, Rett syndrome, childhood disintegrative disorder, and PDD-NOS (pervasive developmental disorder not otherwise specified).

The diagnosis of AS is complicated by the use of several different screening instruments. The diagnostic criteria of the Diagnostic and Statistical Manual are criticized for being vague and subjective. Other sets of diagnostic criteria for AS are the ICD 10 World Health Organization Diagnostic Criteria, Szatmari Diagnostic Criteria, Gillberg Diagnostic Criteria, and Attwood & Gray Discovery Criteria. The ICD-10 definition has similar criteria to the DSM-IV version. Asperger's syndrome had at different times been called Autistic psychopathy and Schizoid disorder of childhood., although those terms are now understood as archaic and inaccurate, and therefore no longer accepted in common use.

Some doctors believe that AS is not a separate and distinct disorder, referring to it as high functioning autism (HFA). The diagnoses of AS or HFA are used interchangeably, complicating prevalence estimates: the same child can receive different diagnoses, depending on the screening tool the doctor uses, and some children will be diagnosed with HFA instead of AS, and vice versa. Many experienced clinicians apply the early onset on High Functioning Autism or the regressive pattern of development as the distinguishing factor in differentiating between AS and HFA. The current classification of the pervasive developmental disorders (PDDs) is unsatisfying to many parents, clinicians, and researchers, and may not reflect the true nature of the conditions. Peter Szatmari, a Canadian researcher of PDD, feels that greater precision is needed to better differentiate between the various PDD diagnoses. The DSM-IV and ICD-10 focus on the idea that discrete biological entities exist within PDD, which leads to a preoccupation with searching for cross-sectional differences between PDD subtypes, a strategy which has not been very useful in classification or in clinical practice.

Characteristics

AS is characterized by:

• Limited interests or preoccupation with a subject to the exclusion of other activities;
• Repetitive behaviors or rituals;
• Peculiarities in speech and language;
• Socially and emotionally inappropriate behaviour and interpersonal interaction;
• Problems with nonverbal communication; and,
• Clumsy and uncoordinated motor movements.

The most common and important characteristics of AS can be divided into several broad categories: social impairments, narrow but intense interests, and peculiarities of speech and language. Other features are commonly associated with this syndrome, but are not always regarded as necessary for diagnosis. This section mainly reflects the views of Attwood, Gillberg, and Wing on the most important characteristics of AS; the DSM-IV criteria represent a slightly different view. Unlike most forms of PDDs, AS is often camouflaged, and many people with the disorder blend in with those that do not have it. The effects of AS depend on how an affected individual responds to the syndrome itself.

Social differences

Although there is no single feature that all people with AS share, difficulties with social behaviour are nearly universal and are one of the most important defining criteria. People with AS lack the natural ability to see the subtexts of social interaction, and may lack the ability to communicate their own emotional state, resulting in well-meaning remarks that may offend, or finding it hard to know what is "acceptable". The unwritten rules of social behaviour that mystify so many with AS have been termed the " hidden curriculum". People with AS must learn these social skills intellectually rather than intuitively.

Non- autistics are able to gather information about other people's cognitive and emotional states based on clues gleaned from the environment and other people's facial expression and body language, but, in this respect, people with AS are impaired; this is sometimes called mind-blindness.

A person with AS may have trouble understanding the emotions of other people: the messages that are conveyed by facial expression, eye contact and body language are often missed. They also might have trouble showing empathy with other people. Thus, people with AS might be seen as egotistical, selfish or uncaring. In most cases, these are unfair labels because affected people are neurologically unable to understand other people's emotional states. They are usually shocked, upset and remorseful when told that their actions are hurtful or inappropriate. It is clear that people with AS do not lack emotions. The concrete nature of emotional attachments they might have (i.e., to objects rather than to people), however, often seems curious or can even be a cause of concern to people who do not share their perspective.

Failing to show affection—or not doing so in conventional ways—does not necessarily mean that people with AS do not feel it. Understanding this can lead partners or care-givers to feel less rejected and to be more understanding. Increased understanding can also come from learning about AS and any comorbid disorders. Sometimes, the opposite problem occurs; the person with AS is unusually affectionate to significant others and misses or misinterprets signals from the other partner, causing the partner stress.

Speech and language differences

People with AS typically have a highly pedantic way of speaking, using a far more formal register of language than appropriate for a context. A five-year-old child with this condition may regularly speak in language that could easily have come from a university textbook, especially concerning his or her special area of interest.

Literal interpretation is another common, but not universal hallmark of this condition. Attwood gives the example of a girl with AS who answered the telephone one day and was asked, "Is Paul there?" Although the Paul in question was in the house, he was not in the room with her, so after looking around to ascertain this, she simply said "no" and hung up. The person on the other end had to call back and explain to her that he meant for her to find him and get him to pick up the telephone.

Individuals with AS may use words idiosyncratically, including new coinages and unusual juxtapositions. This can develop into a rare gift for humor (especially puns, wordplay, doggerel and satire). A potential source of humor is the eventual realization that their literal interpretations can be used to amuse others. Some are so proficient at written language as to qualify as hyperlexic. Tony Attwood refers to a particular child's skill at inventing expressions, e.g., "tidying down" (the opposite of tidying up) or "broken" (when referring to a baby brother who cannot walk or talk).

Children with AS may show advanced abilities for their age in language, reading, mathematics, spatial skills, or music, sometimes into the 'gifted' range, but these talents may be counterbalanced by appreciable delays in the development of other cognitive functions. Some other typical behaviors are echolalia, the repetition or echoing of verbal utterances made by another person, and palilalia, the repetition of one's own words.

A 2003 study investigated the written language of children and youth with AS. They were compared to neurotypical peers in a standardized test of written language skills and legibility of handwriting. In written language skills, no significant differences were found between standardized scores of both groups; however, in hand-writing skills, the AS participants produced significantly fewer legible letters and words than the neurotypical group. Another analysis of written samples found that people with AS appear to be able to write quantitatively similarly to their neurotypical peers using grammatical rules, but have difficulty in producing qualitative writing.

Tony Attwood states that a teacher may spend considerable time interpreting and correcting an AS child's indecipherable scrawl. The child is also aware of the poor quality of his or her handwriting and may be reluctant to engage in activities that involve extensive writing. Unfortunately for some children and adults, high school teachers and prospective employers may consider the neatness of handwriting as a measure of intelligence and personality. The child may require assessment by an occupational therapist and remedial exercises, but modern technology can help minimize this problem. A parent or teacher aide could also act as the child's scribe or proofreader to ensure the legibility of the child's written answers or homework.

Narrow, intense interests

AS can involve an intense and obsessive level of focus on things of interest. Particularly common interests are: means of transport (e.g., trains), computers, foreign languages, mathematics, science fiction, fantasy, astronomy, geography, history, and dinosaurs. Note that many of these are normal interests in ordinary children; the difference in children with AS is the unusual intensity of their interest. Some have suggested that these "obsessions" are essentially arbitrary and lacking in any real meaning or context, but recent research has suggested that this isn't usually the case.

Sometimes these interests are lifelong; in other cases, they change at unpredictable intervals. In either case, there are normally one or two interests at any given time. In pursuit of these interests, people with AS often manifest extremely sophisticated reasoning, an almost obsessive focus, and a remarkably good memory for trivial facts (occasionally even eidetic memory). Hans Asperger called his young patients "little professors" because he thought his patients had as comprehensive and nuanced an understanding of their field of interest as university professors.

Some clinicians do not entirely agree with this description. For example, Wing and Gillberg both argue that, in children with AS, these areas of intense interest typically involve more rote memorization than real understanding, despite occasional appearances to the contrary. Such a limitation is an artifact of the diagnostic criteria, even under Gillberg's criteria, however.

People with AS may have little patience for things outside these narrow interests. In school, they may be perceived as highly intelligent underachievers or overachievers, clearly capable of outperforming their peers in their field of interest, yet persistently unmotivated to do regular homework assignments (sometimes even in their areas of interest). Others may be hypermotivated to outperform peers in school. The combination of social problems and intense interests can lead to unusual behaviour, such as greeting a stranger by launching into a lengthy monologue about a special interest rather than introducing oneself in the socially-accepted way. However, in many cases adults can outgrow this impatience and lack of motivation and develop more tolerance to new activities and meeting new people.

Other differences

Those affected by AS may show a range of other sensory, developmental, and physiological anomalies. Children with AS may evidence a slight delay in the development of fine motor skills. In some cases, people with AS may have an odd way of walking, and may display compulsive finger, hand, arm or leg movements, including tics and stims.

In general, orderly things appeal to people with AS. Some researchers mention the imposition of rigid routines (on self or others) as a criterion for diagnosing this condition. It appears that changes to their routines cause inordinate levels of anxiety for some people with this condition.

Some people with AS experience varying degrees of sensory overload and are extremely sensitive to touch, smells, sounds, tastes, and sights. They may prefer soft clothing, familiar scents, or certain foods. Some may even be pathologically sensitive to loud noises (as some people with AS have hyperacusis), strong smells, or dislike being touched; for example, certain children with AS exhibit a strong dislike of having their head touched or their hair disturbed while others like to be touched but dislike loud noises. Sensory overload may exacerbate problems faced by such children at school, where levels of noise in the classroom can become intolerable for them. Some are unable to block out certain repetitive stimuli, such as the constant ticking of a clock. Whereas most children stop registering this sound after a short time and can hear it only if they consciously attend to it, a child with AS can become distracted, agitated, or even (in cases where the child has problems with regulating emotions such as anger) aggressive if the sound persists. A study of parent measures of child temperament found that children with autism were rated as presenting with more extreme scores than typically-developing children.

History

In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a condition primarily marked by social isolation. He also stated that "exceptional human beings must be given exceptional educational treatment, treatment which takes into account their special difficulties. Further, we can show that despite abnormality, human beings can fulfill their social role within the community, especially if they find understanding, love and guidance".

Hans Asperger and Leo Kanner identified essentially the same population, although the group identified by Asperger was perhaps more "socially functional" than Kanner's. Traditionally, Kannerian autism is characterized by significant cognitive and communicative deficiencies, including delays in or lack of language. A person with AS will not show delays in language, however.

Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s” syndrome. Wing’s writings were widely published and popularized. In 1992, the tenth published edition of the World Health Organization’s diagnostic manual and the International Classification of Diseases (ICD-10) included AS, making it a distinct diagnosis. Later, in 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the American Psychiatric Association’s diagnostic reference book also added AS.

Uta Frith (an early researcher of Kannerian autism) wrote that people with AS seem to have more than a touch of autism to them. Others, such as Lorna Wing and Tony Attwood, share Frith's assessment. Dr. Sally Ozonoff, of the University of California at Davis's MIND Institute, argues that there should be no dividing line between "high-functioning" autism and AS, and that the fact that some people do not start to produce speech until a later age is no reason to divide the two groups because they are identical in the way they need to be treated.

Clinical perspective

Research

Some research is to seek information about symptoms to aid in the diagnostic process. Other research is to identify a cause, although much of this research is still done on isolated symptoms. Many studies have exposed base differences in areas such as brain structure. To what end is currently unknown; research is ongoing, however.

Peter Szatmari suggests that AS was promoted as a diagnosis to spark more research into the syndrome: "It was introduced into the official classification systems in 1994 and has grown in popularity as a diagnosis, even though its validity has not been clearly established. It is interesting to note that it was introduced not so much as an indication of its status as a 'true' disorder, but more to stimulate research ... its validity is very much in question."

Research into causes

The direct cause(s) of AS is unknown. Even though no consensus exists for the cause(s) of AS, it is widely accepted that AS has a hereditary factor. It is suspected that multiple genes play a part in causing AS, since the number and severity of symptoms vary widely among individuals. Studies regarding the mirror neurons in the inferior parietal cortex have revealed differences which may underlie certain cognitive anomalies such as some of those which AS exhibits (e.g., understanding actions, learning through imitation, and the simulation of other people's behaviour). Non-neurological factors such as poverty, lack of sleep, substance abuse by the mother during pregnancy, discrimination, trauma during early childhood, and abuse may also contribute.

Other possible causative mechanisms include a serotonin dysfunction and cerebellar dysfunction. Simon Baron-Cohen proposes a model for autism based on his empathising-systemising (E-S) theory. The E-S theory holds that the female brain is predominantly hard-wired for empathy, while the male brain is predominantly hard-wired for understanding and building systems, and that AS is an extreme of the male brain.

Other research

There are several studies linking autism with differences in brain-volumes such as enlarged amygdala and hippocampus. Current research points to structural abnormalities in the brain as a cause of AS. These abnormalities impact neural circuits that control thought and behaviour. Researchers suggest that gene/environment interactions cause some genes to turn on or turn off, or turn on too much or too little in the wrong places, and this interferes with the normal migration and wiring of embryonic brain cells during early development.

Other finds include brain region differences, such as decreased gray matter density in portions of the temporal cortex which are thought to play into the pathophysiology of ASDs (particularly in the integration of visual stimuli and affective information), and differing neural connectivity. Research on infants points to early differences in reflexes, which may be able to serve as an "early detector" of AS and autism.

Some professionals believe AS is not necessarily a disorder and thus should not be described in medical terms.

Treatment

Treatment coordinates therapies that address the core symptoms of AS: poor communication skills, obsessive or repetitive routines, and physical clumsiness. AS and high-functioning autism may be considered together for the purpose of clinical management.

A typical treatment program generally includes:

• social skills training, to teach the skills to more successfully interact with others;
• cognitive behavioural therapy, to help in better managing emotions that may be explosive or anxious, and to cut back on obsessive interests and repetitive routines;
• medication, for co-existing conditions such as depression and anxiety;
• occupational or physical therapy, to assist with sensory integration problems or poor motor coordination;
• specialized speech therapy, to help with the trouble of the "give and take" in normal conversation; and,
• parent training and support, to teach parents behavioural techniques to use at home.

Many studies have been done on early behavioural interventions. Most of these are single case with one to five participants. The single case studies are usually about controlling non-core autistic problem-behaviors like self-injury, aggression, noncompliance, stereotypies, or spontaneous language. Packaged interventions such as those run by UCLA or TEACCH are designed to treat the entire syndrome and have been found to be somewhat effective.

Unintended side effects of medication and intervention have largely been ignored in the literature about treatment programs for children or adults, and there are claims that some treatments are not ethical and do more harm than good.

Prognosis

Persons with AS appear to have normal lifespans, but have an increased prevalence of comorbid psychiatric conditions such as depression, mood disorders, and obsessive-compulsive disorder.

Children with AS can learn to manage their differences, but they may continue to find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

Individuals with AS may make great intellectual contributions: published case reports suggest an association with accomplishments in computer science, mathematics, and physics. The deficits associated with AS may be debilitating, but many individuals experience positive outcomes, particularly those who are able to excel in areas less dependent on social interaction, such as mathematics, music, and the sciences.

Epidemiology

The prevalence of AS is not well established, but conservative estimates using the DSM-IV criteria indicate that two to three of every 10,000 children have the condition, making it rarer than autistic disorder itself. Three to four times as many boys have AS compared with girls. The universality of AS across races, and validity of epidemiologic studies to date, is questioned.

A 1993 broad-based population study in Sweden found that 36 per 10,000 school-aged children met Gillberg's criteria for AS, rising to 71 per 10,000 if suspected cases are included. The estimate is convincing for Sweden, but the findings may not apply elsewhere because they are based on a homogeneous population. The Sweden study demonstrated that AS may be more common than once thought and may be currently underdiagnosed. Gillberg estimates 30-50% of all persons with AS are undiagnosed. A survey found that 36 per 10,000 adults with an IQ of 100 or above may meet criteria for AS.

Leekam et al. documented significant differences between Gillberg's criteria and the ICD-10 criteria. Considering its requirement for "normal" development of cognitive skills, language, curiosity and self-help skills, the ICD-10 definition is considerably more narrow than Gillberg's criteria, which more closely matches Hans Asperger's own descriptions.

Like other autism spectrum disorders, AS prevalence estimates for males are higher than for females, but some clinicians believe that this may not reflect the actual incidence rates. Tony Attwood suggests that females learn to better compensate for their impairments due to gender differences in the handling of socialization. The Ehlers & Gillberg study found a 4:1 male to female ratio in subjects meeting Gillberg's criteria for AS, but a lower 2.3:1 ratio when suspected or borderline cases were included.

The prevalence of AS in adults is not well understood, but Baron-Cohen et al. documented that 2% of adults score higher than 32 in his Autism Spectrum Quotient (AQ) questionnaire, developed in 2001 to measure the extent to which an adult of normal intelligence has the traits associated with autism spectrum conditions. All interviewed high-scorers met at least 3 DSM-IV criteria, and 63% met threshold criteria for an ASD diagnosis; a Japanese study found similar AQ Test results.

Comorbidities

Most patients presenting in clinical settings with AS have other comorbid psychiatric disorders. Children are likely to present with attention-deficit hyperactivity disorder (ADHD), while depression is a common diagnosis in adolescents and adults. A study of referred adult patients found that 30% presenting with ADHD had ASD as well.

Research indicates people with AS may be far more likely to have the associated conditions. People with AS symptoms may frequently be diagnosed with clinical depression, oppositional defiant disorder, antisocial personality disorder, Tourette syndrome, ADHD, general anxiety disorder, bipolar disorder, obsessive compulsive disorder or obsessive-compulsive personality disorder. Dysgraphia, dyspraxia, dyslexia or dyscalculia may also be diagnosed.

The particularly high comorbidity with anxiety often requires special attention. One study reported that about 84 percent of individuals with a Pervasive Developmental Disorder (PDD) also met the criteria to be diagnosed with an anxiety disorder. Because of the social differences experienced by those with AS, such as trouble initiating or maintaining a conversation or adherence to strict rituals or schedules, additional stress to any of these activities may result in feelings of anxiety, which can negatively affect multiple areas of one's life, including school, family, and work. Treatment of anxiety disorders that accompany a PDD can be handled in a number of ways, such as through medication or individual and group cognitive behavioural therapy, where relaxation or distraction-type activities may be used along with other techniques in order to diffuse the feelings of anxiety.

Non-clinical perspective

Some professionals contend that, far from being a disease, AS is simply the pathologizing of neurodiversity that should be celebrated, understood and accommodated instead of "treated" or "cured".

Shift in view

Autistic people have contributed to a shift in perception of autism spectrum disorders as complex syndromes rather than diseases that must be cured. Proponents of this view reject the notion that there is an 'ideal' brain configuration and that any deviation from the norm is pathological. They demand tolerance for what they call their neurodiversity in much the same way physically handicapped people have demanded tolerance. These views are the basis for the autistic rights and autistic pride movements. Researcher Simon Baron-Cohen has argued that high-functioning autism is a "difference" and is not necessarily a "disability." He contends that the term "difference" is more neutral, and that this small shift in a term could mean the difference between a diagnosis of AS being received as a family tragedy, or as interesting information, such as learning that a child is left-handed.

Autistic culture

People with AS may refer to themselves in casual conversation as "aspies", coined by Liane Holliday Willey in 1999, or as an "Aspergian". The term neurotypical (NT) describes a person whose neurological development and state are typical, and is often used to refer to people who are non-autistic.

A Wired magazine article, The Geek Syndrome, suggested that AS is more common in the Silicon Valley, a haven for computer scientists and mathematicians. It posited that AS may be the result of assortative mating by geeks in mathematical and technological areas. AS can be found in all occupations, however, and is not limited to those in the math and science fields.

The popularization of the Internet has allowed individuals with AS to communicate with each other in a way that was not possible to do offline due to the rarity and the geographic dispersal of individuals with AS. As a result of increasing ability to connect with one another, a subculture of "Aspies" has formed. Internet sites have made it easier for individuals to connect with each other.

Social impact

AS may lead to problems in social interaction with peers. These problems can be severe or mild depending on the individual. Children with AS are often the target of bullying at school due to their idiosyncratic behaviour, language, interests, and impaired ability to perceive and respond in socially expected ways to nonverbal cues, particularly in interpersonal conflict. Children with AS may be extremely literal and may have difficulty interpreting and responding to sarcasm or banter.

The above problems can even arise in the family; given an unfavourable family environment, the child may be subject to emotional abuse. A child or teen with AS is often puzzled by this mistreatment, unaware of what has been done incorrectly. Unlike other pervasive development disorders, most children with AS want to be social, but fail to socialize successfully, which can lead to later withdrawal and asocial behaviour, especially in adolescence. At this stage of life especially, they risk being drawn into unsuitable and inappropriate friendships and social groups. People with AS often get along a lot better with those considerably older or younger than them, rather than those their own age.

Children with AS often display advanced abilities for their age in language, reading, mathematics, spatial skills, and/or music—sometimes into the "gifted" range—but this may be counterbalanced by considerable delays in other developmental areas. This combination of traits can lead to problems with teachers and other authority figures. A child with AS might be regarded by teachers as a "problem child" or a "poor performer." The child’s extremely low tolerance for what they perceive to be ordinary and mediocre tasks, such as typical homework assignments, can easily become frustrating; a teacher may well consider the child arrogant, spiteful, and insubordinate. Lack of support and understanding, in combination with the child's anxieties, can result in problematic behaviour (such as severe tantrums, violent and angry outbursts, and withdrawal).

Although adults with AS may have similar problems, they are not as likely to be given treatment as a child would. They may find it difficult finding employment or entering undergraduate or graduate schools because of poor interview skills or a low score on standardized or personality tests. They also may be more vulnerable to poverty and homelessness than the general population, because of their difficulty finding (and keeping) employment, lack of proper education, premature social skills, and other factors. If they do become employed, they may be misunderstood, taken advantage of, paid less than those without AS, and be subject to bullying and discrimination. Communication deficits may mean people at work have difficulty understanding the person with AS, and problems with authority figures continue as difficult, tense relations with bosses and supervisors become prevalent.

People with AS report a feeling of being unwillingly detached from the world around them. They may have difficulty finding a life partner or getting married due to poor social skills and poverty. In a similar fashion to school bullying, the person with AS is vulnerable to problems in their neighbourhood, such as anti-social behaviour and harassment. Due to social isolation, they can be seen as the ' black sheep' in the community and thus may be at risk of wrongful suspicions and allegations from others.

On the other hand, some adults with AS do get married, get graduate degrees, become wealthy, and hold jobs. The intense focus and tendency to work things out logically often grants those people with AS a high level of ability in their field of interest. When these special interests coincide with a materially or socially useful task, the person with AS often can lead a profitable life. The child obsessed with naval architecture may grow up to be an accomplished shipwright. More research is needed on adults with AS.

Adults with AS as parents

One area of study in which more of such research is sorely needed concerns adults with AS who do marry and subsequently become parents. AS adults who marry often find it difficult to stay married; some initial research puts the divorce rate at approximately eighty percent. The resulting split can be fraught with intense or "high" conflict or domestic violence. Custody cases, already often difficult affairs, are complicated when one or both parties has AS. The parenting skills of a person with AS may be inadequate to the task to the point of inflicting long-term psychological damage on children, neurotypical or otherwise, raised in such an environment. Such damage may be even more pronounced when the AS parent goes undiagnosed and fails to receive the intensive help s/he may need in developing and maintaining adequate parenting skills.

Even with support, AS parents simply may not be up to the enormous task. Raising a psychologically healthy child involves complex emotional interaction between parent and child, as well as the ability to avoid parental behaviors damaging to a child's well-being. Typical adult symptoms of AS include the inability to empathize with others, lack of comprehension of the emotions and motives of others, difficulty in holding conversations and actively listening to others, and poor ability to control feelings of anxiety and, importantly, anger and rage, especially in stressful situations. Sheila Jennings Linehan notes that these problems can at times be simply incompatible with successful parenting.

AS parents should not, however, be stereotyped or categorized as evil, uncaring, or intentionally abusive. As Australia's Better Health Channel puts it, "Because the affected person is neurologically unable to understand other people's emotional states, they are usually shocked, upset and remorseful when told their actions were hurtful or inappropriate." Jennings Linehan notes that "problems in parenting are linked directly to the core neuro-cognitive clinical features of Asperger's Syndrome itself", rather than to "character flaws" or "ill will" on the part of parents. Thus it seems clear that more research and better coping strategies are needed on the part of everyone involved in the welfare of a child who has a parent or parents with AS.

Notable cases

AS is sometimes viewed as a syndrome with both advantages and disadvantages, and notable adults with AS or autism have achieved success in their fields. Prominent AS-diagnosed individuals include Nobel Prize-winning economist Vernon Smith, electropop rocker Gary Numan, Vines frontman Craig Nicholls, and Satoshi Tajiri, the creator of Pokémon. Colorado State University professor and author Temple Grandin was diagnosed with autism at a young age, and has used her autism to her advantage in her profession as an animal behaviorist specializing in livestock handling.

Some AS researchers speculate that well-known figures, including Albert Einstein, Isaac Newton, Glenn Gould, Ludwig Wittgenstein, and Stanley Kubrick, had AS because they showed some AS-related tendencies or behaviors, such as intense interest in one subject, or social problems. Autistic rights activists use such speculative diagnoses to argue that it would be a loss to society if autism were cured. Speculative diagnoses, especially posthumous ones, remain controversial, however.